Katharine E Caldwell, Elizabeth C Wood, L Michael Brunt, Lucas P Neff, Carl Westcott, Michael M Awad, Shan L Kalmeta, Vahagn C Nikolian, Maggie E Bosley
{"title":"准备不足:术中胆管造影在外科工作人员中的侵蚀——普外科住院医师腹腔镜胆囊切除术和术中胆管造影经验的全国回顾。","authors":"Katharine E Caldwell, Elizabeth C Wood, L Michael Brunt, Lucas P Neff, Carl Westcott, Michael M Awad, Shan L Kalmeta, Vahagn C Nikolian, Maggie E Bosley","doi":"10.1007/s00464-025-11733-1","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>With the advent of advanced imaging and endoscopy, we hypothesized that IOC resident training has declined and is currently insufficient. To this end, we evaluated the national general surgery resident experience with laparoscopic cholecystectomy both with and without intraoperative cholangiography.</p><p><strong>Methods: </strong>The National Accreditation Council for Graduate Medical Education (ACGME) operative logs were evaluated from 2012 to 2023 for general surgery residents. The number of completed laparoscopic cholecystectomy (CCY) operations and CCY with cholangiogram were evaluated and compared by postgraduate year, program (academic, community, hybrid, military), and resident role (first assistant, surgeon junior, and surgeon chief). ANOVA testing was used to analyze the data.</p><p><strong>Results: </strong>The cholecystectomy case volumes of graduating general surgery residents in all cholecystectomies increased between the 2012-2013 and 2022-2023 academic years (123.9 v 143, p < 0.01). The number of performed CCY + IOC declined significantly over this period (25.1 v 21.6, p = 0.02). University-affiliated programs demonstrated statistically lower numbers of IOCs than community-based (19.3 v 34.1, p < 0.01), hybrid (24.0, p < 0.01), or military programs (26.3, p < 0.01). Community-based programs performed more CCY with IOC than any other group (p < 0.01). Despite the number of CCY + IOC declining during the study period, an increasing percentage of the CCY + IOC were performed by chief (PGY5) residents (p < 0.01).</p><p><strong>Conclusion: </strong>Trainee experience with IOC is declining. The decreased rate and number of IOCs performed by residents has correlated with a \"seniorization\" of resident experience. This change may result in a future general surgeon workforce with inadequate IOC experience and ultimately impact patient safety. To bolster experience with both technique and interpretation, liberal IOC should be advocated for in training environments. A national IOC assessment may be necessary to address this looming deficit.</p>","PeriodicalId":22174,"journal":{"name":"Surgical Endoscopy And Other Interventional Techniques","volume":" ","pages":"3648-3653"},"PeriodicalIF":2.4000,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Failing to prepare: the erosion of intraoperative cholangiography in the rising surgical workforce-a national review of general surgery residents' laparoscopic cholecystectomy and intraoperative cholangiogram experience.\",\"authors\":\"Katharine E Caldwell, Elizabeth C Wood, L Michael Brunt, Lucas P Neff, Carl Westcott, Michael M Awad, Shan L Kalmeta, Vahagn C Nikolian, Maggie E Bosley\",\"doi\":\"10.1007/s00464-025-11733-1\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>With the advent of advanced imaging and endoscopy, we hypothesized that IOC resident training has declined and is currently insufficient. To this end, we evaluated the national general surgery resident experience with laparoscopic cholecystectomy both with and without intraoperative cholangiography.</p><p><strong>Methods: </strong>The National Accreditation Council for Graduate Medical Education (ACGME) operative logs were evaluated from 2012 to 2023 for general surgery residents. The number of completed laparoscopic cholecystectomy (CCY) operations and CCY with cholangiogram were evaluated and compared by postgraduate year, program (academic, community, hybrid, military), and resident role (first assistant, surgeon junior, and surgeon chief). ANOVA testing was used to analyze the data.</p><p><strong>Results: </strong>The cholecystectomy case volumes of graduating general surgery residents in all cholecystectomies increased between the 2012-2013 and 2022-2023 academic years (123.9 v 143, p < 0.01). The number of performed CCY + IOC declined significantly over this period (25.1 v 21.6, p = 0.02). University-affiliated programs demonstrated statistically lower numbers of IOCs than community-based (19.3 v 34.1, p < 0.01), hybrid (24.0, p < 0.01), or military programs (26.3, p < 0.01). Community-based programs performed more CCY with IOC than any other group (p < 0.01). Despite the number of CCY + IOC declining during the study period, an increasing percentage of the CCY + IOC were performed by chief (PGY5) residents (p < 0.01).</p><p><strong>Conclusion: </strong>Trainee experience with IOC is declining. The decreased rate and number of IOCs performed by residents has correlated with a \\\"seniorization\\\" of resident experience. This change may result in a future general surgeon workforce with inadequate IOC experience and ultimately impact patient safety. To bolster experience with both technique and interpretation, liberal IOC should be advocated for in training environments. A national IOC assessment may be necessary to address this looming deficit.</p>\",\"PeriodicalId\":22174,\"journal\":{\"name\":\"Surgical Endoscopy And Other Interventional Techniques\",\"volume\":\" \",\"pages\":\"3648-3653\"},\"PeriodicalIF\":2.4000,\"publicationDate\":\"2025-06-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Surgical Endoscopy And Other Interventional Techniques\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1007/s00464-025-11733-1\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2025/4/28 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q2\",\"JCRName\":\"SURGERY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Surgical Endoscopy And Other Interventional Techniques","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00464-025-11733-1","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/4/28 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
摘要
背景:随着先进影像学和内窥镜的出现,我们假设IOC住院医师培训已经下降,目前不足。为此,我们评估了全国普通外科住院医师在有或没有术中胆道造影的腹腔镜胆囊切除术中的经验。方法:对2012 - 2023年美国全国研究生医学教育认可委员会(ACGME)的普外科住院医师手术日志进行评估。根据研究生年级、项目(学术、社区、混合、军事)和住院医师角色(第一助理、初级外科医生和外科主任)对完成腹腔镜胆囊切除术(CCY)和胆道造影胆囊切除术(CCY)的数量进行评估和比较。采用方差分析对数据进行分析。结果:2012-2013学年和2022-2023学年,在所有胆囊切除术中,普外科住院医师毕业胆囊切除术病例量增加(123.9 vs 143, p)。居民执行ioc的比率和数量的减少与居民经验的“老年化”有关。这一变化可能导致未来的普通外科医生缺乏IOC经验,并最终影响患者安全。为了加强技术和口译方面的经验,应在训练环境中提倡自由的IOC。为了解决这一迫在眉睫的赤字,可能有必要进行一次全国性的国际奥委会评估。
Failing to prepare: the erosion of intraoperative cholangiography in the rising surgical workforce-a national review of general surgery residents' laparoscopic cholecystectomy and intraoperative cholangiogram experience.
Background: With the advent of advanced imaging and endoscopy, we hypothesized that IOC resident training has declined and is currently insufficient. To this end, we evaluated the national general surgery resident experience with laparoscopic cholecystectomy both with and without intraoperative cholangiography.
Methods: The National Accreditation Council for Graduate Medical Education (ACGME) operative logs were evaluated from 2012 to 2023 for general surgery residents. The number of completed laparoscopic cholecystectomy (CCY) operations and CCY with cholangiogram were evaluated and compared by postgraduate year, program (academic, community, hybrid, military), and resident role (first assistant, surgeon junior, and surgeon chief). ANOVA testing was used to analyze the data.
Results: The cholecystectomy case volumes of graduating general surgery residents in all cholecystectomies increased between the 2012-2013 and 2022-2023 academic years (123.9 v 143, p < 0.01). The number of performed CCY + IOC declined significantly over this period (25.1 v 21.6, p = 0.02). University-affiliated programs demonstrated statistically lower numbers of IOCs than community-based (19.3 v 34.1, p < 0.01), hybrid (24.0, p < 0.01), or military programs (26.3, p < 0.01). Community-based programs performed more CCY with IOC than any other group (p < 0.01). Despite the number of CCY + IOC declining during the study period, an increasing percentage of the CCY + IOC were performed by chief (PGY5) residents (p < 0.01).
Conclusion: Trainee experience with IOC is declining. The decreased rate and number of IOCs performed by residents has correlated with a "seniorization" of resident experience. This change may result in a future general surgeon workforce with inadequate IOC experience and ultimately impact patient safety. To bolster experience with both technique and interpretation, liberal IOC should be advocated for in training environments. A national IOC assessment may be necessary to address this looming deficit.
期刊介绍:
Uniquely positioned at the interface between various medical and surgical disciplines, Surgical Endoscopy serves as a focal point for the international surgical community to exchange information on practice, theory, and research.
Topics covered in the journal include:
-Surgical aspects of:
Interventional endoscopy,
Ultrasound,
Other techniques in the fields of gastroenterology, obstetrics, gynecology, and urology,
-Gastroenterologic surgery
-Thoracic surgery
-Traumatic surgery
-Orthopedic surgery
-Pediatric surgery