American Surgical Association Blue Ribbon Committee report on surgical education: 2004
American Surgical Association Blue Ribbon Committee report on surgical education: 2004
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DOI：
10.1097/01.sla.0000150066.83563.52
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发表时间：
2005-01-01
影响因子：
9
通讯作者：
Zinner, MJ
中科院分区：
文献类型：
--
作者：
Debas, HT;Bass, BL;Zinner, MJ
美国外科教育拥有丰富的遗产，其项目培养了一些训练有素、最有能力的外科医生。尽管外科住院医师培训自霍尔斯特德上世纪初制定以来几乎没有变化，但外科住院医师和进修计划继续保持高标准，因为它们是高度结构化、监控、评估和认证的。然而，在 21 世纪之初，众多变革力量正在影响普通医学教育，特别是外科培训。一方面，科学、系统和信息技术的进步带来的知识爆炸为改进我们的培训计划提供了新的机会。另一方面，随着公众对其医疗保健需求和安全性的了解越来越多，其期望也发生了变化，现在越来越需要先进和专业的护理。与之前关于 2010 年医生人数过剩的预测相反，我们似乎正处于医生队伍短缺的边缘。这种迫在眉睫的短缺现象应该结合美国医学院协会 (AAMC) 的数据来看待。该数据显示，自 1996 年以来，美国医学院的申请者人数已下降了 25%。现在，进入医学院的学生中有近 50% 是女性。现在，美国医学生平均毕业时背负的债务超过 10 万美元。越来越多的男女学生选择比普通外科生活方式更可控的专业。此外，普通外科住院医师的流失率接近 20%，这主要是由于住院医师的生活方式问题。手术实践已经发生了重大变化，并且预计还会有更多变化。许多临床护理已从住院医院转移到门诊，住院患者的住院时间显着缩短。这些转变对本科生和研究生的医学/外科教育产生了重大影响。外科护理正在从基于学科的实践转向基于疾病的实践，其中外科医生将越来越多地在专家团队中进行实践。我们如何培训外科医生成为这样的多学科团队的领导者？认识到正在发生的众多变化，并在美国外科协会 (ASA) 2002 年年会上主席讲话的引领下，ASA 理事会与美国外科医师学会 (ACS)、美国外科委员会 (ABS) 和外科住院医师审查委员会 (RRC-S) 合作，于 2002 年 6 月成立了外科教育蓝丝带委员会。委员会负责审查影响医疗保健的多种力量，并就外科教育所需的变革提出建议，以加强外科医生的培训，满足国家所有外科手术的需求，并使外科手术的培训和研究保持在 21 世纪的前沿。本报告基于 ASA 蓝带委员会在 2 年期间所做的工作和获得的咨询。委员会很快认识到其任务的复杂性，以及任何重大变革建议都可能引起包括委员会本身成员在内的许多利益相关者之间的争议。然而，委员会逐渐达成了共识。在另一个方面，ABS 对于如何重组手术培训计划也得出了类似的结论。委员会
American surgical education has a rich heritage, and its programs produce some of the best trained and most competent surgeons. Although surgery residency training has changed little since its formulation by Halsted at the beginning of the last century, surgery residency and fellowship programs continue to maintain high standards because they are highly structured, monitored, evaluated, and credentialed. At the dawn of the 21st Century, however, numerous forces for change are impacting medical education in general and surgical training in particular. On the one hand, the explosion of knowledge from the advances of science, systems, and information technology provide new opportunities to improve our training programs. On the other hand, as the public has become increasingly better informed about its healthcare needs and safety, its expectation has shifted and now increasingly demands advanced and specialized care. Contrary to earlier predictions of excess physicians by 2010, we appear to be on the threshold of a shortage in physician workforce. This impending shortage should be viewed in the context of Association of American Medical Colleges (AAMC) data, which show that the number of applicants to medical schools in the United States has declined by 25% since 1996. Now, nearly 50% of students entering medical school are women. The average US medical student now graduates with a debt in excess of $100,000. Students of both genders are increasingly selecting specialties with more controllable lifestyles than general surgery. Furthermore, general surgery residencies experience an attrition rate of nearly 20%, primarily because of lifestyle concerns of residents. Major changes have occurred and more are foreseen in the practice of surgery. Much clinical care has moved from the inpatient hospital setting to the outpatient, and the length of stay for inpatients has significantly decreased. These shifts have resulted in a significant impact on both undergraduate and graduate medical/surgical education. Surgical care is moving from discipline-based to disease-based practice in which surgeons will increasingly practice within a team of experts. How do we train surgeons to be leaders of such multidisciplinary teams?Recognizing the multitude of changes taking place, and spearheaded by the Presidential Address at the 2002 annual meeting of the American Surgical Association (ASA), the ASA Council in partnership with the American College of Surgeons (ACS), the American Board of Surgery (ABS), and the Resident Review Committee for Surgery (RRC-S), established a Blue Ribbon Committee on Surgical Education in June 2002. The Committee was charged with examining the multitude of forces impacting health care and making recommendations regarding the changes needed in surgical education to enhance the training of surgeons to serve all the surgical needs of the nation, and to keep training and research in surgery at the cutting edge in the 21st Century. This report is based on the work done and consultations obtained by the ASA Blue Ribbon Committee over a 2-year period. The Committee quickly recognized the complexity of its tasks and how any major recommendation for change could provoke controversy among many stakeholders, including members of the committee itself. Gradually, however, the committee was able to arrive at a consensus. On a separate track, the ABS has come to similar conclusions on how to restructure the surgery training program. The Committee