Variability in Integrated Cardiothoracic Training Program Curriculum
Variability in Integrated Cardiothoracic Training Program Curriculum
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DOI：
10.1016/j.athoracsur.2017.01.079
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发表时间：
2017-06-01
影响因子：
4.6
通讯作者：
LaPar, Damien J.
中科院分区：
文献类型：
--
作者：
Stephens, Elizabeth H.;Walters, Dustin M.;LaPar, Damien J.
背景。如何将住院医师从医学院毕业生适当地培养为训练有素的心胸外科医生，是心胸外科综合培训项目的一个关键挑战。本研究考察了综合课程的可变性和可感知的挑战。对2016年TSDA/TSRA调查的回应进行了分析，该调查伴随着当前心胸外科住院医师的年度培训考试。使用标准统计方法来检查参与者回答的趋势。普通外科经验随着研究生年级的增加而减少，而心脏手术经验则增加。在各种各样的辅助领域的旋转是常见的。大多数（87%）受访者报告有专门的心胸重症监护病房（ICU）轮转，而外科ICU和心脏监护病房轮转不太常见（分别为68%和42%）。最常见的外科亚专科轮换是血管外科（94%）和急症护理外科（88%），临床暴露时间范围广（血管外科为3-44周）。重要的是，52%的人感到与普通外科住院医生的经验竞争，22.5%的普通外科轮转是在没有普通外科住院医生的医院进行的。感知到的挑战包括优化轮转（78%），教师允许住院医师执行病例组件（60%），教师在手术室教学（29%），以及改善普通外科轮转的手术经验（19%）。综合心胸外科课程存在显著差异。优化旋转，获得手术经验，并与普通外科整合似乎是最重要的挑战。这些数据表明，优化机构内的早期临床和手术经验可以提高受训者对高级心胸外科培训的准备。(C) 2017年由胸外科医师协会发布
Background. Development of curricula that appropriately progress a resident from medical school graduate to fully trained cardiothoracic surgeon is a key challenge for integrated cardiothoracic training programs. This study examined variability and perceived challenges in integrated curricula.Methods. Responses to the 2016 TSDA/TSRA survey that accompanies the annual in-training exam taken by current cardiothoracic surgery residents were analyzed. Standard statistical methods were utilized to examine trends in participant responses.Results. General surgery experience decreased with post-graduate year, whereas cardiac operative experience increased. Rotations in a wide variety of adjunct fields were common. The majority (87%) of respondents reported had dedicated cardiothoracic intensive care unit (ICU) rotations, and surgical ICU and cardiac care unit rotations were less common (68% and 42%, respectively). The most common surgical subspecialty rotations were vascular (94%) and acute care surgery (88%), with a wide range of clinical exposure (ie, 3-44 weeks for vascular). Importantly, 52% felt competition with general surgery residents for experience and 22.5% of general surgery rotations were at hospitals without general surgery residents. Perceived challenges included optimization of rotations (78%), faculty allowing residents to perform case components (60%), faculty teaching in the operating room (29%), and improving surgical experience on general surgery rotations (19%).Conclusions. Significant variation exists in integrated cardiothoracic surgery curricula. Optimization of rotations, access to surgical experience, and integration with general surgery appear to be the most significant perceived challenges. These data suggest that optimization of early clinical and surgical experience within institutions could improve trainee preparedness for senior cardiothoracic surgery training. (C) 2017 by The Society of Thoracic Surgeons