Coaching Intervention to Improve Technical Skill in Surgery

描述(由申请人提供)：指导干预以提高手术技能在这个国家，每年有超过15万名接受重大住院手术的患者死亡，更多的患者遭受严重的并发症，导致重大的长期发病率。这些重要的结果在不同的医院和外科医生之间差异很大，这表明有很大的改善机会。虽然大多数改进努力都集中在围手术期护理的一般方面，但越来越多的证据表明，减少手术不良后果的最重要策略可能是提高手术医生的熟练程度。在此背景下，我们将在密歇根州减肥手术协作(MBSC)之前评估技术质量的工作基础上，实施全州范围的技能发展干预。MBSC是进行此类研究的完美实验室，拥有现有的基础设施 为了衡量现有的技术质量，建立了一个临床登记处，记录了40 000多个连续减肥手术的结果数据，并建立了一个由来自35家医院的70名外科医生组成的协作网络，这些医生都有参加技术技能评级和基于人口的改进努力的记录。我们的具体目标是开发一种教练干预，以提高技术技能，并评估其对手术技能和临床结果的影响。这项研究将是第一个应用教练来提高执业外科医生技术技能的大规模研究，具有很高的创新性。这项研究的结果将对外科医生、政策制定者和需要手术的患者产生直接影响。外科医生可以在这项工作的基础上，进一步加强大规模的质量改进计划，专注于提高技术技能。政策制定者可以开发类似的项目，并鼓励外科医生参与其中，以获得认证或董事会认证。最终，患者将成为这项研究的受益者，因为他们的外科医生变得更熟练，他们遭受的术后并发症更少。

DESCRIPTION (provided by applicant): Coaching Intervention to Improve Technical Skill in Surgery Each year in this country more than 150,000 patients undergoing major inpatient surgery die, and many more suffer serious complications leading to major long term morbidity. These important outcomes vary widely across hospitals and surgeons, suggesting large opportunities for improvement. While most improvement efforts have focused on general aspects of perioperative care, emerging evidence suggests that the most important strategy for reducing adverse outcomes of surgery may be to improve the proficiency of the operating surgeon. In this context, we will build on our prior work evaluating technical quality in the Michigan Bariatric Surgery Collaborative (MBSC) to implement a statewide skill development intervention. The MBSC is the perfect laboratory for such a study, with the existing infrastructure to measure technical quality in place, a clinical registry with outcomes data for more than 40,000 consecutive bariatric surgery procedures, and a collaborative network of 70 surgeons from 35 hospitals who have a track-record of participating in both the rating of technical skills and in population-based improvement efforts. Our specific aims are to develop a coaching intervention to improve technical skill and to evaluate its impact on surgical skills and clinical outcomes. Thi study will be highly innovative as the first large-scale study to apply coaching to improve technical skills among practicing surgeons. Results from this study will have immediate impact on surgeons, policymakers, and patients in need of surgery. Surgeons can build on this work to further augment large-scale quality improvement programs to focus on improving technical skill. Policy makers could develop similar programs and encourage surgeons to participate in them to achieve accreditation or board-certification. Ultimately, patients will be the beneficiaries of thi research as their surgeons become more skilled and they suffer fewer postoperative complications.