Safety considerations in learning new procedures: a survey of surgeons
Safety considerations in learning new procedures: a survey of surgeons
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DOI：
10.1016/j.jss.2017.06.058
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发表时间：
2017-10-01
影响因子：
2.2
通讯作者：
Dimick, Justin B.
中科院分区：
文献类型：
--
作者：
Jaffe, Todd A.;Hasday, Steven J.;Dimick, Justin B.
背景：外科创新与安全之间存在着矛盾。与引入新程序/技术相关的学习曲线与可预防的患者伤害有关。外科医生对学习新手术/技术的方法的安全性的看法在很大程度上是不明确的。材料和方法：设计了一项调查来评估外科医生对学习新手术/技术的看法。这包括两个领域的临床小插曲：(1)手术经验（如结肠切除术）和(2)技术经验（如腹腔镜）。本研究还侧重于外科医生对现有资格/特权要求的看法。参与者是中西部两家大型学术健康中心的外科医生（n = 150）。结果：调查回复率为77%（116/150）。69%的受访者认为，对于确保患者安全而言，认证/特权流程“过于宽松”或“过于宽松”。外科医生通常表示，需要一个小型奖学金来学习新的腹腔镜手术。然而，这一要求根据外科医生先前的腹腔镜手术经验而有所不同。例如，为了学习腹腔镜结肠切除术，35%的受访者认为腹腔镜经验有限的外科医生应该完成一个小型奖学金，而3%的人认为如果外科医生有丰富的腹腔镜经验，这是必要的。在后一种情况下，大多数受访者认为外科医生在学习腹腔镜结肠切除术时应该在专家（38%）或在监考人员的监督下进行手术（33%）。结论：许多外科医生认为现有的医院认证/特权做法可能过于宽松。此外，外科医生认为，培训执业外科医生的“一刀切”方法可能无法保护患者免受不安全的新手术/技术的引入。(C) 2017爱思唯尔公司版权所有。
Background: There exists a tension between surgical innovation and safety. The learning curve associated with the introduction of new procedures/technologies has been associated with preventable patient harm. Surgeon's perceptions regarding the safety of methods for learning new procedures/technologies are largely uncharacterized.Materials and methods: A survey was designed to evaluate surgeons' perceptions related to learning new procedures/technologies. This included clinical vignettes across two domains: (1) experience with an operation (e.g., colectomy) and (2) experience with a technology (e.g., laparoscopy). This study also focuses on a surgeon's perceptions of existing credentialing/privileging requirements. Participants were faculty surgeons (n = 150) at two large Midwestern academic health centers.Results: Survey response rate was 77% (116/150). 69% of respondents believed the processes of credentialing/privileging is "far too relaxed" or "too relaxed" for ensuring patient safety. Surgeons most commonly indicated a mini-fellowship is required to learn a new laparoscopic procedure. However, that requirement differed based on a surgeon's prior experience with laparoscopy. For example, to learn laparoscopic colectomy, 35% of respondents felt a surgeon with limited laparoscopic experience should complete a mini-fellowship, whereas 3% felt this was necessary if the surgeon had extensive laparoscopic experience. In the latter scenario, most respondents felt a surgeon should scrub in cases performed by an expert (38%) or perform cases under a proctor's supervision (33%) when learning laparoscopic colectomy.Conclusions: Many surgeons believe existing hospital credentialing/privileging practices may be too relaxed. Moreover, surgeons believe the "one-size-fits-all" approach for training practicing surgeons may not protect patients from unsafe introduction of new procedures/technologies. (C) 2017 Elsevier Inc. All rights reserved.