Subin Punnen, Shayda Taheri, Leo Chen, Tracy Scott, Ahmer Karimuddin
{"title":"比较学术培训基地、城市社区培训基地和农村培训基地住院医师常规普外科手术量。","authors":"Subin Punnen, Shayda Taheri, Leo Chen, Tracy Scott, Ahmer Karimuddin","doi":"10.1503/cjs.005323","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Surgical training traditionally took place at academic centres, but changed to incorporate community and rural hospitals. As little data exist comparing resident case volumes between these locations, the objective of this study was to determine variations in these volumes for routine general surgery procedures.</p><p><strong>Methods: </strong>We analyzed senior resident case logs from 2009 to 2019 from a general surgery residency program. We classified training centres as academic, community, and rural. Cases included appendectomy, cholecystectomy, hernia repair, bowel resection, adhesiolysis, and stoma formation or reversal. We matched procedures to blocks based on date of case and compared groups using a Poisson mixed-methods model and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>We included 85 residents and 28 532 cases. Postgraduate year (PGY) 3 residents at academic sites performed 10.9 (95% CI 10.1-11.6) cases per block, which was fewer than 14.7 (95% CI 13.6-15.9) at community and 15.3 (95% CI 14.2-16.5) at rural sites. Fourth-year residents (PGY4) showed a greater difference, with academic residents performing 8.7 (95% CI 8.0-9.3) cases per block compared with 23.7 (95% CI 22.1-25.4) in the community and 25.6 (95% CI 23.6-27.9) at rural sites. This difference continued in PGY5, with academic residents performing 8.3 (95% CI 7.3-9.3) cases per block, compared with 18.9 (95% CI 16.8-21.0) in the community and 14.5 (95% CI 7.0-21.9) at rural sites.</p><p><strong>Conclusion: </strong>Senior residents performed fewer routine cases at academic sites than in community and rural centres. Programs can use these data to optimize scheduling for struggling residents who require exposure to routine cases, and help residents complete the requirements of a Competence by Design curriculum.</p>","PeriodicalId":9573,"journal":{"name":"Canadian Journal of Surgery","volume":null,"pages":null},"PeriodicalIF":2.2000,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233171/pdf/","citationCount":"0","resultStr":"{\"title\":\"Comparing resident operative volumes for routine general surgery cases at academic, urban community, and rural training sites.\",\"authors\":\"Subin Punnen, Shayda Taheri, Leo Chen, Tracy Scott, Ahmer Karimuddin\",\"doi\":\"10.1503/cjs.005323\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Surgical training traditionally took place at academic centres, but changed to incorporate community and rural hospitals. As little data exist comparing resident case volumes between these locations, the objective of this study was to determine variations in these volumes for routine general surgery procedures.</p><p><strong>Methods: </strong>We analyzed senior resident case logs from 2009 to 2019 from a general surgery residency program. We classified training centres as academic, community, and rural. Cases included appendectomy, cholecystectomy, hernia repair, bowel resection, adhesiolysis, and stoma formation or reversal. We matched procedures to blocks based on date of case and compared groups using a Poisson mixed-methods model and 95% confidence intervals (CIs).</p><p><strong>Results: </strong>We included 85 residents and 28 532 cases. Postgraduate year (PGY) 3 residents at academic sites performed 10.9 (95% CI 10.1-11.6) cases per block, which was fewer than 14.7 (95% CI 13.6-15.9) at community and 15.3 (95% CI 14.2-16.5) at rural sites. Fourth-year residents (PGY4) showed a greater difference, with academic residents performing 8.7 (95% CI 8.0-9.3) cases per block compared with 23.7 (95% CI 22.1-25.4) in the community and 25.6 (95% CI 23.6-27.9) at rural sites. This difference continued in PGY5, with academic residents performing 8.3 (95% CI 7.3-9.3) cases per block, compared with 18.9 (95% CI 16.8-21.0) in the community and 14.5 (95% CI 7.0-21.9) at rural sites.</p><p><strong>Conclusion: </strong>Senior residents performed fewer routine cases at academic sites than in community and rural centres. Programs can use these data to optimize scheduling for struggling residents who require exposure to routine cases, and help residents complete the requirements of a Competence by Design curriculum.</p>\",\"PeriodicalId\":9573,\"journal\":{\"name\":\"Canadian Journal of Surgery\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":2.2000,\"publicationDate\":\"2024-07-04\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11233171/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Canadian Journal of Surgery\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1503/cjs.005323\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/7/1 0:00:00\",\"PubModel\":\"Print\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Surgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1503/cjs.005323","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/7/1 0:00:00","PubModel":"Print","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景:外科培训传统上是在学术中心进行的,但随着社区医院和乡村医院的加入而发生了变化。由于几乎没有数据可以比较这些地方的住院医师病例量,本研究的目的是确定这些地方常规普外科手术病例量的变化:我们分析了 2009 年至 2019 年普外科住院医师培训项目的高级住院医师病例记录。我们将培训中心分为学术中心、社区中心和农村中心。病例包括阑尾切除术、胆囊切除术、疝修补术、肠切除术、粘连溶解术、造口形成或翻转术。我们根据病例日期将手术与区块进行匹配,并使用泊松混合方法模型和 95% 置信区间 (CI) 对各组进行比较:结果:我们纳入了 85 名住院医师和 28 532 个病例。学术机构的研究生三年级住院医师每区进行了 10.9(95% CI 10.1-11.6)例手术,少于社区机构的 14.7(95% CI 13.6-15.9)例手术和农村机构的 15.3(95% CI 14.2-16.5)例手术。第四年的住院医师(PGY4)显示出更大的差异,学术型住院医师每区完成 8.7(95% CI 8.0-9.3)个病例,而社区为 23.7(95% CI 22.1-25.4)个,农村为 25.6(95% CI 23.6-27.9)个。这种差异在 PGY5 继续存在,学术住院医师每单元完成 8.3(95% CI 7.3-9.3)个病例,而社区住院医师每单元完成 18.9(95% CI 16.8-21.0)个病例,农村住院医师每单元完成 14.5(95% CI 7.0-21.9)个病例:结论:与社区和农村中心相比,学术机构的高年资住院医师进行的常规病例较少。教学计划可以利用这些数据为需要接触常规病例的困难住院医师优化时间安排,并帮助住院医师完成 "能力设计 "课程的要求。
Comparing resident operative volumes for routine general surgery cases at academic, urban community, and rural training sites.
Background: Surgical training traditionally took place at academic centres, but changed to incorporate community and rural hospitals. As little data exist comparing resident case volumes between these locations, the objective of this study was to determine variations in these volumes for routine general surgery procedures.
Methods: We analyzed senior resident case logs from 2009 to 2019 from a general surgery residency program. We classified training centres as academic, community, and rural. Cases included appendectomy, cholecystectomy, hernia repair, bowel resection, adhesiolysis, and stoma formation or reversal. We matched procedures to blocks based on date of case and compared groups using a Poisson mixed-methods model and 95% confidence intervals (CIs).
Results: We included 85 residents and 28 532 cases. Postgraduate year (PGY) 3 residents at academic sites performed 10.9 (95% CI 10.1-11.6) cases per block, which was fewer than 14.7 (95% CI 13.6-15.9) at community and 15.3 (95% CI 14.2-16.5) at rural sites. Fourth-year residents (PGY4) showed a greater difference, with academic residents performing 8.7 (95% CI 8.0-9.3) cases per block compared with 23.7 (95% CI 22.1-25.4) in the community and 25.6 (95% CI 23.6-27.9) at rural sites. This difference continued in PGY5, with academic residents performing 8.3 (95% CI 7.3-9.3) cases per block, compared with 18.9 (95% CI 16.8-21.0) in the community and 14.5 (95% CI 7.0-21.9) at rural sites.
Conclusion: Senior residents performed fewer routine cases at academic sites than in community and rural centres. Programs can use these data to optimize scheduling for struggling residents who require exposure to routine cases, and help residents complete the requirements of a Competence by Design curriculum.
期刊介绍:
The mission of CJS is to contribute to the meaningful continuing medical education of Canadian surgical specialists, and to provide surgeons with an effective vehicle for the dissemination of observations in the areas of clinical and basic science research.