初级住院医师“关键指标”手术：一种追踪初级住院医师手术准备度的方法

文献信息

中文摘要

目的： 为初级住院医师制定一组“初级关键指标手术”（JKIPs），以便于追踪和培养成功完成更高级手术所需的基本技能。
设计： 回顾了威斯康星大学耳鼻咽喉-头颈外科住院医师在2016年6月24日至2023年6月23日期间的ACGME病例日志。纳入记录为“住院医师术者”或“住院医师监督者”的手术，使用手术“类型”类别进行分析，并按毕业后年份（PGY）进行比较。在定量方面，通过比较手术经验轨迹（达到50%病例经验的时间）的均值和方差与KIPs来评估手术类型。为每个拟议的初级关键指标手术（JKIP）构建了手术经验的增长曲线。
场所： 威斯康星大学麦迪逊分校，一所拥有耳鼻咽喉-头颈外科住院医师培训项目的三级医疗中心。
参与者： 回顾性审查了18名住院医师7年间的病例日志数据。
结果： 分析了18名住院医师的病例日志（29,457条病例记录）。分析得出了九项具有足够数量、可靠性、亚专科代表性并与KIPs相关联的JKIPs：气管切开术、无听骨链重建（OCR）的鼓室成形术、鼓膜切开术/鼓膜置管术、皮肤病变切除及一期缝合、复杂撕裂伤修复、内镜鼻窦手术、扁桃体切除术和腺样体切除术、鼻中隔成形术，以及伴或不伴活检的硬性喉镜检查。
结论： 耳鼻咽喉-头颈外科住院医师在PGY 4-5完成大多数KIPs。已确定了一组通常由初级住院医师（PGY 1-3）完成的手术，可用作JKIPs。开发了一组模型来评估初级住院医师在JKIPs方面的经验。

英文摘要

OBJECTIVE: To develop a group of "Junior Key Indicator Procedures" (JKIPs) for junior residents to facilitate tracking and development of basic skills necessary for success in more advanced procedures.
DESIGN: ACGME case logs for Oto-HNS residents at the University of Wisconsin were reviewed between 6/24/2016 and 6/23/2023. Procedures logged as "Resident Surgeon" or "Resident Supervisor" were included, analyzed using the procedure "Type" category, and compared by post graduate year (PGY). Quantitatively, procedure types were assessed by comparison of mean and variance of operative experience trajectory (time to 50% of case experience) against KIPs. Growth curves of operative experience were constructed for each proposed Junior Key Indicator Procedure (JKIP).
SETTING: University of Wisconsin-Madison, a tertiary care center with an Otolaryngology-Head & Neck Surgery Residency training program.
PARTICIPANTS: The case log data of 18 residents over 7 years was retrospectively reviewed.
RESULTS: Case logs of 18 residents (29,457 case entries) were analyzed. Analysis resulted in nine JKIPs with adequate volume, reliability, sub-specialty representation, and linkage with KIPs: tracheostomy, tympanoplasty without ossicular chain reconstruction (OCR), myringotomy/tympanostomy, resection skin lesion & primary closure, repair complex laceration, endoscopic sinus surgery, tonsillectomy and adenoidectomy, septoplasty, and rigid laryngoscopy w/wo biopsy.
CONCLUSIONS: Oto-HNS residents complete most KIPs in PGY 4-5. A subset of procedures that are commonly completed by junior residents (PGY 1-3) has been identified for use as JKIPs. A set of models were developed to evaluate junior resident experience with the JKIPs.