Readiness of US General Surgery Residents for Independent Practice

被引：261

作者：

George, Brian C. ^{[1
]}

Bohnen, Jordan D. ^{[2
]}

Williams, Reed G. ^{[3
]}

Meyerson, Shari L. ^{[4
]}

Schuller, Mary C. ^{[4
]}

Clark, Michael J. ^{[5
]}

Meier, Andreas H. ^{[6
]}

Torbeck, Laura ^{[2
]}

Mandell, Samuel P. ^{[7
]}

Mullen, John T. ^{[1
]}

Smink, Douglas S. ^{[8
]}

Scully, Rebecca E. ^{[9
]}

Chipman, Jeffrey G. ^{[10
]}

Auyang, Edward D. ^{[11
]}

Terhune, Kyla P. ^{[12
]}

Wise, Paul E. ^{[13
]}

Choi, Jennifer N. ^{[2
]}

Foley, Eugene F. ^{[14
]}

Dimick, Justin B. ^{[5
]}

Choti, Michael A. ^{[15
]}

Soper, Nathaniel J. ^{[4
]}

Lillemoe, Keith D. ^{[1
]}

Zwischenberger, Joseph B. ^{[16
]}

Dunnington, Gary L. ^{[2
]}

DaRosa, Debra A. ^{[4
]}

Fryer, Jonathan P. ^{[4
]}

机构：

[1] Univ Michigan, Dept Surg, Ann Arbor, MI 48109 USA

[2] Massachusetts Gen Hosp, Boston, MA 02114 USA

[3] Indiana Univ, Bloomington, IN USA

[4] Northwestern Univ, Evansville, IN USA

[5] Univ Michigan, Ann Arbor, MI 48109 USA

[6] SUNY Upstate Med Univ, Syracuse, NY 13210 USA

[7] Univ Washington, Seattle, WA 98195 USA

[8] Brigham & Williams Hosp, Boston, MA USA

[9] Brigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA

[10] Univ Minnesota, Minneapolis, MN USA

[11] Univ New Mexico, Albuquerque, NM 87131 USA

[12] Vanderbilt Univ, 221 Kirkland Hall, Nashville, TN 37235 USA

[13] Washington Univ, St Louis, MO USA

[14] UT Southwestern, Dallas, TX USA

[15] Univ Wisconsin, Madison, WI USA

[16] Univ Kentucky, Lexington, KY USA

来源：

ANNALS OF SURGERY | 2017年 / 266卷 / 04期

关键词：

assessment; autonomy; independent practice; performance; readiness; resident; simpl; surgical education; OPERATIVE PERFORMANCE; MEDICAL-EDUCATION; ACS-NSQIP; AUTONOMY; ENTRUSTMENT; COMPETENCE; FELLOWSHIP; MILESTONES; DECISION; QUALITY;

D O I：

10.1097/SLA.0000000000002414

中图分类号：

R61 [外科手术学];

学科分类号：

摘要：

Objective: This study evaluates the current state of the General Surgery (GS) residency training model by investigating resident operative performance and autonomy. Background: The American Board of Surgery has designated 132 procedures as being "Core'' to the practice of GS. GS residents are expected to be able to safely and independently perform those procedures by the time they graduate. There is growing concern that not all residents achieve that standard. Lack of operative autonomy may play a role. Methods: Attendings in 14 General Surgery programs were trained to use a) the 5-level System for Improving and Measuring Procedural Learning (SIMPL) Performance scale to assess resident readiness for independent practice and b) the 4-level Zwisch scale to assess the level of guidance (ie, autonomy) they provided to residents during specific procedures. Ratings were collected immediately after cases that involved a categorical GS resident. Data were analyzed using descriptive statistics and supplemented with Bayesian ordinal model-based estimation. Results: A total of 444 attending surgeons rated 536 categorical residents after 10,130 procedures. Performance: from the first to the last year of training, the proportion of Performance ratings for Core procedures (n = 6931) at "Practice Ready'' or above increased from 12.3% to 77.1%. The predicted probability that a typical trainee would be rated as Competent after performing an average Core procedure on an average complexity patient during the last week of residency training is 90.5% (95% CI: 85.7%-94%). This falls to 84.6% for more complex patients and to less than 80% for more difficult Core procedures. Autonomy: for all procedures, the proportion of Zwisch ratings indicating meaningful autonomy ("Passive Help'' or "Supervision Only'') increased from 15.1% to 65.7% from the first to the last year of training. For the Core procedures performed by residents in their final 6 months of training (cholecystectomy, inguinal/femoral hernia repair, appendectomy, ventral hernia repair, and partial colectomy), the proportion of Zwisch ratings (n = 357) indicating near-independence ("Supervision Only'') was 33.3%. Conclusions: US General Surgery residents are not universally ready to independently perform Core procedures by the time they complete residency training. Progressive resident autonomy is also limited. It is unknown if the amount of autonomy residents do achieve is sufficient to ensure readiness for the entire spectrum of independent practice.

引用

页码：582 / 594

页数：13

共 39 条

[1] Does resident involvement effect surgical times and complication rates during laparoscopic appendectomy for uncomplicated appendicitis? An analysis of 16,849 cases from the ACS-NSQIP Discussion [J].