Relationship of procedural numbers with meaningful procedural autonomy in general surgery residents.

Autor: Stride HP; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., George BC; Department of Surgery, University of Michigan, Ann Arbor, Michigan., Williams RG; Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana., Bohnen JD; Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts., Eaton MJ; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Schuller MC; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Zhao L; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Yang A; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Meyerson SL; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Scully R; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts., Dunnington GL; Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana., Torbeck L; Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana., Mullen JT; Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts., Mandell SP; Department of Surgery, Harborview Medical Center, University of Washington, Seattle, Washington., Choti M; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas., Foley E; Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin., Are C; Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska., Auyang E; Department of Surgery, University of New Mexico School of Medicine, Albuquerque, New Mexico., Chipman J; Department of Surgery, University of Minnesota Medical School, Minneapolis, Minnesota., Choi J; Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana., Meier A; Department of Surgery, State University of New York Update Medical University, Syracuse, New York., Smink D; Department of Surgery, Brigham and Women's Hospital, Boston, Massachusetts., Terhune KP; Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee., Wise P; Department of Surgery, Washington University School of Medicine, St. Louis, Missouri., DaRosa D; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Soper N; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois., Zwischenberger JB; Department of Surgery, University of Kentucky College of Medicine, Lexington, Kentucky., Lillemoe K; Department of Surgery, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts., Fryer JP; Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Electronic address: jfryer@nm.org.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2018 Mar; Vol. 163 (3), pp. 488-494. Date of Electronic Publication: 2017 Dec 23.
DOI: 10.1016/j.surg.2017.10.011
Abstrakt: Background: Concerns exist regarding the competency of general surgery graduates with performing core general surgery procedures. Current competence assessment incorporates minimal procedural numbers requirements.
Methods: Based on the Zwisch scale we evaluated the level of autonomy achieved by categorical PGY1-5 general surgery residents at 14 U.S. general surgery resident training programs between September 1, 2015 and December 31, 2016. With 5 of the most commonly performed core general surgery procedures, we correlated the level of autonomy achieved by each resident with the number of procedures they had performed before the evaluation period, with the intent of identifying specific target numbers that would correlate with the achievement of meaningful autonomy for each procedure with most residents.
Results: Whereas a definitive target number was identified for laparoscopic appendectomy (i.e. 25), for the other 4 procedures studied (i.e. laparoscopic cholecystectomy, 52; open inguinal hernia repair, 42; ventral hernia repair, 35; and partial colectomy, 60), target numbers identified were less definitive and/or were higher than many residents will experience during their surgical residency training.
Conclusions: We conclude that procedural target numbers are generally not effective in predicting procedural competence and should not be used as the basis for determining residents' readiness for independent practice.
(Copyright © 2017. Published by Elsevier Inc.)
Databáze: MEDLINE
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