我们的外科教育计划侧重于帮助住院医生发展最好的外科技能, and providing valuable feedback to improve their performance. To advance those objectives, 我们与外科教育的趋势保持同步，并继续评估住院医生参与手术直接影响患者护理的方式.

How can you best assess surgical skills in the operating room?

评估手术室的手术技能仍然是一个挑战. Therefore, 我们创建了一个电子资源，以帮助确保整形外科培训计划符合下一个认证系统(NAS)里程碑和研究生医学教育认证委员会(ACGME)所要求的变化。. MileMarkerTM是我们用来评估整形外科住院医师的网络工具. It is made up of the Operative Entrustability Assessment (OEA), a rapid electronic assessment of resident operating room performance completed after each surgery; a data dashboard displaying graphical summaries of resident progress by case and NAS Milestone group; and an electronic Milestones tracker. 所有这些都有助于我们对手术室住院医生的数据进行持续的培训评估. This gives immediate feedback to trainees, creates assessment transparency, lets trainees self-monitor their progress, and informs end-of-rotation reviews, program-wide assessments, and tailor training to address specific needs.

手术信赖度评价(OEA)在自体乳房重建术和手部手术病例的研究中显示出其价值, 表明较高的OEA评分与较短的手术时间相关. Additionally, OEA评分比住院医师研究生年(PGY)更能预测手术时间的缩短, or level of training). 

Learn more about Dr. Lifchez's work on the Milemarker Assessment Tool. 

What operative performance feedback do you provide to residents?

对住院医生手术表现的反馈对外科培训至关重要. 我们做了多项研究评估外科住院医师和同事对手术表现反馈需求的看法. 我们还研究了主治医生提供反馈的及时性是否对反馈的可靠性有影响. These studies have shown that residents and fellows find verbal, 面对面的反馈非常或极其重要，并且更倾向于在案例中或案例结束后立即给出反馈. 然而，外科受训者仍然重视在事件发生后一周内给予的反馈. 我们的研究也证明了主治医生在完成手术病例后两周内给予住院医师的OEA评估分数的可靠性.

独立和综合培训计划的操作绩效趋势

整形外科培训可以通过以下两种途径之一来完成:(1)独立途径, which includes completing a general, orthopedic, or other surgery residency and an additional 3 years of plastic surgery training; or (2) the integrated pathway, 其中包括5年或6年的整形外科培训而没有事先完成外科住院医师培训. 许多整形外科培训项目正在取消他们独立的培训途径. 检查独立和综合住院医生之间的差异可能有助于项目决定是否保留独立的培训途径. 本研究旨在区分综合(PGY4-PGY6)和独立(PGY1-PGY3)整形外科住院医师的手术能力. OEA的数据显示，在第一年的前三个季度，独立整形外科住院医生的表现略低于他们的整合同事. However, they show a similar level of competency after this period. 这表明，在整形外科培训项目中，两种类型的住院医生在手术技能方面的缺点最小.

Does resident involvement affect surgical care?

定期地，推荐十大正规网赌平台会担心住院医生参与他们的手术护理. 尽管一些研究调查了住院医生参与某些外科手术的术后结果, 住院医师介入与即刻乳房重建手术发病率之间的关系并没有很好的文献记载.

我们做这项研究是为了了解住院医生参与立即乳房重建是否与30天手术发病率的增加有关, readmission and reoperation rates, operative time, and length of stay. We found that in immediate breast reconstruction patients, resident involvement was not associated with any of those measures.. However, operative time was greater when residents were participating, 虽然时间根据住院医师的培训水平有所不同. These findings were statistically significantly. 这些数据支持住院医师参与乳房重建手术的安全性, 并且可以用于为那些可能担心住院医生参与手术护理的患者提供咨询.