后事少：退伍军人医院委托专业活动中普外科住院医师经验的职业化。

IF 2.6 3区医学 Q1 EDUCATION, SCIENTIFIC DISCIPLINES

Journal of Surgical Education Pub Date : 2025-01-11 DOI:10.1016/j.jsurg.2024.103403

Tiffany K. Brocke MD, MHPE , Daniel B. Eaton Jr MPH , Cali E. Johnson MD, EdD , Coen Klos MD , Michael M. Awad MD, PhD, MHPE , Kerri A. Ohman MD

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引用次数: 0

摘要

目标：确定普外科住院医师自主权和住院医师研究生年级（PGY）在委托专业活动（EPA）案例中的变化：确定普外科住院医师自主权和住院医师研究生年级（PGY）水平在可委托专业活动（EPA）案例中随着时间推移而发生的变化：设计：回顾性队列研究：美国退伍军人事务（VA）医院系统，2004年至2020年：2004年至2020年期间，在退伍军人事务部外科质量改进项目数据库中，所有接受12个普通外科EPA中任何一个EPA手术的患者，其手术内容均可识别：结果：确定了 452,549 个病例。从 2004 年到 2020 年，住院医师操作的病例减少了 61.4%，主治医师协助的病例减少了 14.3%，而主治医师操作的病例增加了 51.8%。在研究期间，所有 EPA 的住院医师自主权都出现了统计学意义上的显著下降，住院医师操作的病例也出现了向主治医师操作的净转移。在研究期间，12 个 EPA 中约有 7 个 EPA 的住院医师 PGY 水平在主治医师协助下的病例数有明显增加：腹壁疝、良性/恶性乳腺、良性/恶性结肠、皮肤/皮下肿瘤、胆囊疾病、腹股沟疝和软组织感染。约有 3 个 EPA 的住院医师 PGY 显著增加：腹壁疝、良性/恶性乳腺和腹股沟疝。其中许多变化代表着住院医师手术经验的年资增加了 3 到 12 个月：结论：在退伍军人事务部的所有普外科 EPA 中，住院医师的手术自主权持续下降。此外，随着时间的推移，许多EPA病例已转移到更高年资的住院医师手中，从而延迟或推迟了这些病例在培训期间的自主完成。虽然这些数据来自退伍军人事务部系统，但结果很可能反映出其他环境中住院外科医生的自主权也在持续下降。随着普外科适应以能力为基础的教育模式，我们需要采取行动来稳定这些变化，以实现可持续的外科研究生教育。

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Doing Less Later: Seniorization of General Surgery Resident Operative Experience in the Entrustable Professional Activities at Veterans Affairs Hospitals

OBJECTIVE

Identify changes in general surgery resident autonomy and resident postgraduate year (PGY) level in Entrustable Professional Activity (EPA) cases over time.

DESIGN

Retrospective cohort study.

SETTING

United States Veterans Affairs (VA) hospital system, 2004 to 2020.

PARTICIPANTS

All patients undergoing operations in any of the 12 general surgery EPAs with identifiable operative components captured by the VA Surgical Quality Improvement Project database from 2004 to 2020.

RESULTS

452,549 cases were identified. Between 2004 and 2020, there was a 61.4% decrease in resident-performed cases and a 14.3% decrease in attending-assisted cases, with a concomitant 51.8% increase in attending-performed cases. All EPAs experienced a statistically significant decrease in resident autonomy over the study period, and a net transfer of cases from resident-performed to attending-performed.

About 7 of 12 EPAs had significant increases in the resident PGY level of attending-assisted cases over the study period: abdominal wall hernia, benign/malignant breast, benign/malignant colon, cutaneous/subcutaneous neoplasm, gallbladder disease, inguinal hernia, and soft tissue infection. About 3 EPAs had significant increases in the resident PGY of resident-performed cases: abdominal wall hernia, benign/malignant breast, and inguinal hernia. Many of these changes represented seniorization of the operative experience by 3 to 12 months.

CONCLUSIONS

There has been a continual decrease in resident operative autonomy across all general surgery EPAs at the VA. Furthermore, many EPA cases have shifted to more senior residents over time, delaying or deferring autonomous completion of these cases during training. Although these data were drawn from the VA system, the results likely reflect a continued decrease in autonomy for resident surgeons in other settings as well. As general surgery adapts to a competency-based educational model, action is needed to stabilize these changes for sustainable graduate surgical education.

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来源期刊

Journal of Surgical Education EDUCATION, SCIENTIFIC DISCIPLINES-SURGERY

CiteScore

5.60

自引率

10.30%

发文量

261

审稿时长

48 days

期刊介绍： The Journal of Surgical Education (JSE) is dedicated to advancing the field of surgical education through original research. The journal publishes research articles in all surgical disciplines on topics relative to the education of surgical students, residents, and fellows, as well as practicing surgeons. Our readers look to JSE for timely, innovative research findings from the international surgical education community. As the official journal of the Association of Program Directors in Surgery (APDS), JSE publishes the proceedings of the annual APDS meeting held during Surgery Education Week.