我国249家医院阑尾切除教学手术的开展情况调查

Investigation on the activities of instructional appendectomy in 249 hospitals in China

目的调查我国各级教学医院阑尾切除教学手术的开展情况,为推动临床手术教学工作提供参考。方法2021年3月,南方医科大学南方医院普通外科研究团队采用非随机抽样方法,选取全国28个省(自治区、直辖市)的250家医院(包括大学直属附属医院和省、市、县级的非直属教学医院)的300名临床医师为调查对象,自行设计问卷进行调查,采用描述性统计分析结果数据。结果共有来自249家医院的286名医师参与了调查。目前仍然在开展阑尾切除教学手术的医院占比42.2%(105/249),主要集中在大学直属附属医院[33.3%(35/105)]和市级非直属教学医院[36.2%(38/105)],阑尾切除教学手术的学生主要为接受住院医师规范化培训的医师[74.3%(78/105)]和五年制临床医学专业本科实习学生[56.2%(59/105)];而曾经开展但目前已经停止阑尾切除教学手术的医院占比29.7%(74/249)。77名来自停止阑尾切除教学手术医院的医师认为停止开展的主要原因包括过高的医疗风险[70.1%(54/77)]和医学生临床基础知识较差[42.9%(33/77)];对于未来大范围开展阑尾切除教学手术,93.0%(266/286)的医师表示支持,并指出选择合适的手术方式、增加学生担任第一助手的机会、以及提高学生腹腔镜基础技能,有助于提升教学效果和保障该教学手术的顺利进行。结论我国阑尾切除教学手术的开展面临挑战,重新大范围开展阑尾切除教学手术的可能性依然存在,且腹腔镜技术的广泛应用能够为阑尾切除教学手术注入新的活力。

Objective To investigate the development of instructional appendectomy in teaching hospitals of all levels in China and promote clinical training.Methods In March 2021,300 clinicians from 250 hospitals(including university affiliated hospitals others at the provincial,municipal and county levels)in 28 provinces including autonomous regions and municipalities directly under the central government were selected by non random sampling method.The general surgery research team of Nanfang Hospital of Southern Medical University designed the questionnaire;Descriptive statistics were used to analyze the result data.Results A total of 286 doctors from 249 hospitals participated in the survey.Only 42.2%(105/249)of these hospitals still engaged in the instructional appendectomy and the majority of which are university-affiliated[33.3%(35/105)]and non-directly affiliated municipal ones[36.2%(38/105)].Most trainees participated in the instructional appendectomy are resident doctors from the standardized training program[74.3%(78/105)]and interns[56.2%(59/105)].The proportion of hospitals that gave up appendectomy was 29.7%(74/249).A survey of 77 doctors in these 74 hospitals showed that the main reasons of giving up include high medical risk[70.1%(54/77)]and poor clinical fundamentals among medical students[42.9%(33/77)].From the prospect of resuming instructional appendectomy in the future,93.0%(266/286)of the doctors interviewed expressed their support to appendectomy training and their needs of appropriate surgical approaches,increase of students'chance to join operation as the first assistant,improvement of the clinical knowledge and training of basic laparoscopic skills in order to improve the learning outcomes and ensure the smooth operation.Conclusions The training by instructional appendectomy in China is facing great challenges and the large-scale teaching operation of appendectomy is still feasible.The laparoscopic technology may facilitate clinical training of appendectomy.