Early career surgeon performance - a patient safety blind spot

项目摘要/摘要 最近的一项多机构研究表明，即将毕业的普外科实习生不能独立 执行常见操作的时间超过20%。这些发现引发了人们对是否做好准备的严重担忧 早期职业外科医生提供安全、高质量的外科护理。这些培训的程度 目前尚不清楚缺陷是否会危及患者的安全。更好地理解外科手术之间的关系 要有效地解决这些问题，需要培训、外科医生的表现和患者的预后。最终， 我们必须更新所有外科实习生在毕业前必须达到的标准。确实有, 然而，在充分发挥这种方法的潜力之前，必须解决几个知识差距 意识到了。这项提议的目的是弥合这些差距，并制定未来的政策对策。这个 这项建议的具体研究目的是：(I)确定早期职业外科医生的手术表现 使用国家医疗保险索赔数据中的风险调整结果进行评估；(Ii)确定外科医生的实习生 绩效评级是他们早期职业生涯风险调整后患者结局的有效预测因子；以及(Iii)确定 如果在培训后立即获得外科医生的初步认证可以可靠地区分早期职业外科医生 性能。这项研究将首次确定早期职业外科医生的能力程度 对医疗质量的影响以及现有的学员能力衡量标准是否有助于早期预测 职业表现。这项研究的结果最终可用于实施新的培训标准 确保所有早期职业外科医生都是称职的。这些变化是迫切需要的，以保障 数百万美国患者的健康。该项目还将促进应聘者的职业发展。 经验丰富的多学科导师团队，拟议的职业发展和研究 计划和无与伦比的研究环境是解决职业目标和教育的理想选择 候选人派的需求，马萨诸塞州医学博士布莱恩·乔治。尽管他之前有丰富的评估经验 外科实习生表现，他没有使用联邦医疗保险索赔数据来评估风险调整后的经验 结果。这些技能对于他实现确保所有早期职业外科医生 提供安全护理。因此，这项提议包括额外的培训，这对以下两方面都是必要的 成功完成这项研究和乔治博士的职业发展，包括研究生水平 医疗保险索赔数据分析课程，使用风险调整结果进行绩效衡量， 和高级统计建模。这一职业发展奖将为乔治博士 作为一名独立的调查员和了解如何确保所有外科医生 当他们进入练习阶段时，提供安全护理。

Project Summary/Abstract A recent multi-institutional study suggested that graduating general surgery trainees could not independently perform common operations over 20% of the time. These findings raise serious concerns about the readiness of early career surgeons to provide safe, high-quality surgical care. The degree to which these training deficiencies compromise patient safety is unknown. A better understanding of the relationship between surgical training, surgeon performance, and patient outcomes is needed to effectively tackle these issues. Ultimately, we must update the standards that must be met by all surgical trainees prior to graduation. There are, however, several knowledge gaps that must be addressed before the full potential of this approach can be realized. The purpose of this proposal is to close those gaps and map a policy response moving forward. The specific research aims of this proposal are to (i) determine the operative performance of early career surgeons assessed using risk-adjusted outcomes in national Medicare claims data; (ii) determine if a surgeon’s trainee performance ratings are valid predictors of their early career risk-adjusted patient outcomes; and (iii) determine if initial certification of surgeons immediately after training reliably discriminate early career surgeon performance. This study will, for the first time, determine the degree to which early career surgeon competence impacts health care quality and whether existing measures of trainee competence are useful predictors of early career performance. The results of this study can ultimately be used to implement new training standards to ensure that all early career surgeons are competent. These changes are urgently needed to safeguard the health of millions of American patients. This project will also facilitate the career development of the candidate. The highly experienced and multidisciplinary mentorship team, the proposed career development and research plan, and the unparalleled research environment are ideally suited to address the career goals and educational needs of the candidate PI, Brian George, MD, MA. Although he has substantial prior experience assessing surgical trainee performance, he has no experience using Medicare claims data to assess risk-adjusted outcomes. These skills are necessary for him to achieve his goal of ensuring that all early career surgeons provide safe care. This proposal therefore includes additional training which will be essential both for the successful completion of this research and for Dr. George’s career development, including graduate level courses in Medicare claims data analysis, the use of risk-adjusted outcomes for performance measurement, and advanced statistical modeling. This career development award will lay the groundwork for Dr. George to mature as an independent investigator and national leader in understanding how to ensure all surgeons provide safe care when they enter practice.