See one, do one, teach one - Trends in resident autonomy and teaching assistant cases during general surgery residency in the United States: A nationwide retrospective analysis

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2024-09-10 DOI:10.1016/j.amjsurg.2024.115952

Amir Humza Sohail , Hoang Nguyen , Kevin Martinez , Samuel L. Flesner , Christian Martinez , Mohammed A. Quazi , Aman Goyal , Abu Baker Sheikh , Hassan Aziz , Ammar Asrar Javed , Jennifer Whittington , Loretto Glynn , D'Andrea Joseph , Matthew C. Hernandez

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引用次数: 0

Abstract

Introduction

Autonomy during residency is crucial to the training and development of competent surgeons. An essential component of this process is the ‘teaching assistant (TA)’ case, an indispensable opportunity for residents to gain confidence and hone intraoperative skills. However, high-quality data on the volume and diversity of cases that graduates perform are scarce.

Methods

A retrospective analysis was performed from publicly collected data of operative case logs from general surgery residents graduating from ACGME-accredited programs from 2006 to 2023. Data on the median overall number of surgeon chief and TA cases were retrieved. Collected data were organized based on sub-specialties. The Mann-Kendall trend test was used to investigate trends in TA cases and surgeon chief operative volume.

Results

Between 2007 and 2023, the surgeon chief cases gradually increased from 229 to 274 (19.6 % increase; τ = 0.610, p = 0.001). There was a concurrent 72.7 % increase in TA cases from a median of 22–38 (τ = 0.574, p = 0.001). Surgeon chief (283 per resident) and TA cases (43 per resident) peaked in 2018–2019 and 2016–2017.

The uptrend in TA cases was associated with the significant increase in colorectal (τ = 0.559, p = 0.001), general surgery-other (τ = 0.404, p = 0.018), and hepatopancreaticobiliary (HPB) (τ = 0.596, p = 0.001) subspecialties. Trauma and vascular surgery did not change significantly. With respect to total chief cases, general surgery-other (τ = 0.956, p=<0.001), HPB (τ = 0.713, p=<0.001) and colorectal (τ = 0.522, p = 0.004) volume increased. There was no significant change in trauma and foregut volume, while the volume of endocrine (τ = −0.485, p = 0.006) and vascular surgery (τ = 0.603, p = 0.001) dropped significantly.

The procedural category with the highest chief and TA volume was ‘colorectal tract - large intestine.’ Most procedural categories (53.49 %) retained a median of 0 teaching cases. No chief cases were logged for the specialties generally not considered part of general surgery (genitourinary, nervous system, orthopedics, and gynecology), although a median of 1 surgeon chief genitourinary case was recorded from 2018 to 2023.

Conclusions

Over the past seventeen years, there has been a gradual uptrend in the number of surgeon chief and TA cases. While this is a positive indicator of improved autonomy, further research must focus on strategies to improve resident autonomy to train well-rounded surgeons safely.

查看原文本刊更多论文

看一个，做一个，教一个--美国普外科住院医师培训期间住院医师自主权和助教病例的趋势：全国范围内的回顾性分析。

导言：住院医师培训期间的自主性对于培养合格的外科医生至关重要。教学助手（TA）"病例是这一过程的重要组成部分，是住院医师获得信心和磨练术中技能不可或缺的机会。然而，有关毕业生所完成病例的数量和多样性的高质量数据却很少：我们从公开收集的 2006 年至 2023 年 ACGME 认可项目毕业的普外科住院医师的手术病例日志数据中进行了回顾性分析。检索了外科医生主任病例和助教病例总数的中位数数据。收集的数据根据亚专科进行整理。采用Mann-Kendall趋势检验法研究TA病例和外科医生主任手术量的趋势：2007年至2023年期间，外科医生主刀病例从229例逐渐增加到274例（增加19.6%；τ = 0.610，p = 0.001）。同时，助产士病例也从中位数的 22-38 例增加了 72.7%（τ = 0.574，p = 0.001）。外科医生主任（每位住院医师 283 例）和 TA 病例（每位住院医师 43 例）在 2018-2019 年和 2016-2017 年达到高峰。TA病例的上升趋势与结直肠（τ = 0.559，p = 0.001）、普通外科-其他（τ = 0.404，p = 0.018）和肝胆胰（HPB）（τ = 0.596，p = 0.001）亚专科的显著增加有关。创伤和血管外科没有明显变化。就主治病例总数而言，普外科-其他（τ = 0.956，p=结论：在过去的十七年中，外科医生主治病例和TA病例的数量呈逐渐上升趋势。虽然这是自主性提高的一个积极指标，但进一步的研究必须侧重于提高住院医师自主性的策略，以安全地培养全面发展的外科医生。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.