Zhifei Wang1, Yi Lu1, Songjia Tang2. 1Hepatobiliary, pancreatic and minimally invasive surgery, Zhejiang Provincial People’s Hospital, 2Zhejiang University, Medical School
Abstract Objective: To explore the current concerns the Chinese young residents have during their standardized resident training, taking the resident’s experience in the digestive disease surgery department of four large scaled(more than 2500 beds) teaching hospitals as an example.
Methods: The survey was sent to 135 residents from 4 hospitals in Hangzhou.Results 102 surveys were returned(75.6% response rate). Most of them had a 6 to 12-month long training in digestive disease center. Results The average study time after work was less than 2 hours per day for 94.11% residents, largely spent on reading medical related SCI articles and writing papers for academic publication. And only 22.55% of them spent 1 hour per week exercising on surgical models (mainly suturing and knotting) while the rest had no time for model training. During work, 10-30% time was spent on writing medical record, 5-20% time was spent on ward rounding, 30-50% time was spent on operation and less than 10% time on study and case discussion. Though a large amount of time was spent on operation, 60.78% residents admitted they did not have confidence to perform any surgery independently after surgical training in digestive disease center. First of all, only 35.29% residents did preoperative study on every operation they involved and only 7.84% claimed 100 % preparation achieved before operation.Most attendings and fellows did not check residents’ preparation before surgery and had trouble instructionally communicating with residents. Lots of residents were needed at surgery as a result of lack of laborn other than teaching purpose. Retraction, trimming and suction were 3 mostly performed procedures by residents yet incision, suturing, knotting and dissection were their mostly desired procedures during surgical training. Too much decumental work occupied quite large amount of time in the operation room and reduces hands-on exposure opportunities giving the fact that there is no PA in Chinese hospitals. When doctors finished their surgical training, 34.31% did not take evaluation tests, 48.04% took theoretical tests and only 17.65% took operational tests, which hindered objective qualification and skill improvements by positive or negative feedbacks.
Conclusions: The residency education and evaluation system remained to be improved. More than 70% residents expressed they would lose heart in surgery without operation opportunity. Taking several factors into consideration, surgical simulation might be ideal compensation for lack of hands-on practice, which could help residents get more ready and understand better about the surgery.