美国鼻科专科培训：一项全国性调查的启示

文献信息

中文摘要

背景： 随着鼻科专科培训项目的迅速扩张，追求专科培训的耳鼻咽喉科受训者比例也有所增加。评估受训者动机、期望和结果的当代数据仍然有限。本研究评估了7年间美国鼻科专科培训学员的当代数据，以了解其动机、期望和结果。
方法： 采用前瞻性与回顾性相结合的调查研究，于2018年至2025年期间对美国鼻科专科培训项目的入学和结业学员进行问卷调查。调查评估了动机、手术操作舒适度、科研期望、职业规划及总体满意度。对回答进行了描述性分析。
结果： 共分析241份回答（124份入学学员，117份结业学员）。参加专科培训的主要动机是提升手术技能和临床决策能力，较少受访者提及科研或导师指导。学员对标准内镜鼻窦手术报告了较高的舒适度，但对高级颅底和鼻整形技术的信心较低。受保护的科研时间不一致，16%-45%的结业学员报告没有科研时间，这与入学时的期望不同。对2年制专科培训的兴趣较低（入学学员29% vs. 结业学员18%）。虽然71.8%的入学学员预期从事学术职业，但最终64.1%进入了学术实践。总体满意度较高，86.3%报告专科培训达到了期望。报告的不足包括颅底暴露有限、手术自主权减少、计费/编码培训不足以及科研时间不够。
结论： 鼻科专科培训学员接受亚专科培训主要是为了提升手术技能和临床决策能力。尽管绝大多数人认为培训达到了期望，但预期与实际经历之间仍存在有意义的差距，尤其是在受保护的学术时间、高级手术操作的暴露以及非临床技能培养方面。

英文摘要

BACKGROUND: The proportion of otolaryngology trainees pursuing fellowship has increased alongside rapid expansion in rhinology fellowship programs. Contemporary data evaluating trainee motivations, expectations, and outcomes remain limited. This study assesses contemporary data evaluating trainee motivations, expectations, and outcomes among US rhinology fellows over a 7-year period.
METHODS: A combined prospective and retrospective survey study was conducted using questionnaires administered to incoming and outgoing fellows at US rhinology fellowship programs from 2018 to 2025. Surveys evaluated motivations, procedural comfort, research expectations, career plans, and overall satisfaction. Responses were analyzed descriptively.
RESULTS: A total of 241 responses were analyzed (124 incoming, 117 outgoing). The primary motivation for fellowship was to enhance surgical skills and clinical decision-making, with fewer respondents citing research or mentorship. Fellows reported high comfort with standard endoscopic sinus procedures but lower confidence with advanced skull base and rhinoplasty techniques. Protected research time was inconsistent, with 16%-45% of graduating fellows reporting none, differing from incoming expectations. Interest in a 2-year fellowship was low (29% incoming vs. 18% outgoing). While 71.8% of incoming fellows anticipated academic careers, 64.1% ultimately entered academic practice. Overall satisfaction was high, with 86.3% reporting that fellowship met expectations. Reported shortcomings included limited skull base exposure, reduced surgical autonomy, inadequate billing/coding training, and insufficient research time.
CONCLUSION: Rhinology fellowship trainees primarily pursue subspecialty training to enhance surgical skills and clinical decision-making. Although training is overwhelmingly perceived as meeting expectations, meaningful gaps persist between anticipated and actual experiences, particularly in protected academic time, exposure to advanced procedures, and non-clinical skill development.