PDF(Pubmed)
Abstract：
Background A national survey of general surgery residents revealed significant self-assessed deficits in preparation for independent practice, with only 7.7% of graduating postgraduate year 5 residents (n=1145) reporting self-efficacy for all 10 commonly performed operations surveyed. Objective We sought to understand why this phenomenon occurs. We hypothesized that self-efficacy would be positively correlated with both operative independence and case volume. Methods We compared 3 independent datasets: case information for the same 10 previously surveyed operations for residents graduating in 2020 (dataset 1), operative independence data obtained through the SIMPL OR app, an operative self-assessment tool (dataset 2), and case volume data obtained through the Accreditation Council for Graduate Medical Education National Data Report (dataset 3). Operations were categorized into high, middle (mid), and low self-efficacy tiers; analysis of variance was used to compare operative independence and case volume per tier. Results There were significant differences in self-efficacy between high (87.7%), mid (68.3%), and low (25.4%) tiers (P=.008 [95% CI 6.2, 32.7] for high vs mid, P<.001 for high vs low [49.1, 75.6], and P<.001 for mid vs low [28.7, 57.1]). The percentage of cases completed with operative independence followed similar trends (high 32.7%, mid 13.8%, low 4.9%, P=.006 [6.4, 31.4] for high vs mid, P<.001 [15.3, 40.3] for high vs low, P=.23 [-4.5, 22.3] for mid vs low). The total volume of cases decreased from high to mid to low self-efficacy tiers (average 91.8 to 20.8 to 11.1) but did not reach statistical significance on post-hoc analysis. Conclusions In this analysis of US surgical residents, operative independence was strongly correlated with self-efficacy.
摘要：
背景一项针对普外科住院医师的全国调查显示，在为独立执业做准备时，自我评估的严重缺陷。只有7.7％的研究生5年级毕业生（n=1145）报告了所有10例常见手术的自我效能感。目的我们试图了解这种现象发生的原因。我们假设自我效能感与手术独立性和病例量均呈正相关。方法我们比较了3个独立的数据集：2020年毕业的居民的10个先前调查的手术的病例信息(数据集1)，通过SIMPL或应用程序获得的手术独立性数据，可操作的自我评估工具(数据集2)，以及通过研究生医学教育认证委员会国家数据报告（数据集3）获得的病例量数据。操作被分类为高，middle(mid),和低自我效能层；方差分析用于比较手术独立性和每层病例量。结果高(87.7%)患者的自我效能感,中期（68.3%），和低（25.4%）层（P=.008[95%CI6.2，32.7]，高和中，高与低的P<.001[49.1,75.6]，中等和低的P<.001[28.7,57.1])。完成手术独立的病例百分比遵循类似的趋势(高32.7%，中期13.8%，低4.9%，高与中的P=.006[6.4，31.4]，高与低的P<.001[15.3,40.3]，P=.23[-4.5，22.3]对于中低）。病例总量从高到中到低自我效能层（平均91.8到20.8到11.1）下降，但在事后分析中没有达到统计学意义。结论在对美国外科住院医师的分析中，手术独立性与自我效能密切相关。
