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

doi:10.3760/cma.j.cn115259-20210616-00759

Abstract

Abstract: 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.

Key words: Appendectomy, Clinical teaching;Surgical teaching, Survey

CLC Number:

Zhao Mingli, Liang Weiqi, Chen Xinhua, Chen Tao, Chen Hao, Lin Tian, Zhao Liying, Liu Hao, Hu Yanfeng, Li Guoxin, Yu Jiang. Investigation on the activities of instructional appendectomy in 249 hospitals in China[J]. Chinese Journal of Medical Education, 2022, 42(4): 349-353.

References

[1] 王涛, 张璐, 赵经文, 等. 阑尾炎治疗进展及相关性疾病 [J]. 中国处方药, 2021, 19(2): 20-23. DOI: 10.3969/j.issn.1671-945X.2021.02.010.
[2] Bhangu A, Sreide K, Di Saverio S, et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management[J]. Lancet, 2015,386(10000):1278-1287. DOI: 10.1016/S0140-6736(15)00275-5.
[3] Kalliainen LK, Lichtman DM. Current issues in the physician-patient relationship[J]. J Hand Surg Am, 2010,35(12):2126-2129. DOI: 10.1016/j.jhsa.2010.06.012.
[4] 周燕红, 王瑶芬, 高卉, 等. 改革医学临床实践技能教学培养高素质医学人才[J]. 咸宁学院学报, 2009, 29(5): 142-143. DOI: 10.16751/j.cnki.hbkj.2009.05.059.
[5] Scott-Conner CE, Hall TJ, Anglin BL, et al. Laparoscopic appendectomy. Initial experience in a teaching program[J]. Ann Surg, 1992,215(6):660-667; discussion 667-668. DOI: 10.1097/00000658-199206000-00013.
[6] Chiu CC, Wei PL, Wang W, et al. Role of appendectomy in laparoscopic training[J]. J Laparoendosc Adv Surg Tech A, 2006,16(2):113-118. DOI: 10.1089/lap.2006.16.113.
[7] Hiramatsu K, Toda S, Tate T, et al. Can laparoscopic appendectomy be safely performed by surgical residents without prior experience of open appendectomy?[J]. Asian J Surg, 2018,41(3):270-273. DOI: 10.1016/j.asjsur.2016.12.003.
[8] 潘庆霞, 梁立波, 吴群红,等. 公立医院医患关系紧张的原因及对策探讨——基于医患双方视角的分析[J]. 中国医院管理, 2016, 36(5): 68-70.
[9] 国家卫生和计划生育委员会. 2016中国卫生和计划生育统计年鉴 [M]. 北京:中国协和医科大学出版社, 2016:23-70.
[10] 梅浙川. 临床和科研业绩在医生职称晋升中的权重[J].中国医院,2014,18(3):51. DOI: 10.3969/j.issn.1671-0592.2014.03.025.
[11] 赵嘉芸, 耿敏, 吴丹, 等. 临床医学专业硕士研究生临床技能培养现状调查与对策研究[J].中华医学教育杂志,2014,34(1):138-140. DOI: 10.3760/cma.j.issn.1673-677X.2014.01.043.
[12] 顾炜珺, 陆梅华. 上海某儿童专科医院临床教师带教意愿调查分析[J].解放军医院管理杂志,2012,19(11):1079-1081. DOI: 10.3969/j.issn.1008-9985.2012.11.037.
[13] 谢建芳, 吴莲叶, 沈晨霞, 等. 上海郊区某临床教学医院师资队伍建设现状及需求调查 [J]. 中国继续医学教育, 2021, 13(08): 68-73. DOI: 10.3969/j.issn.1674-9308.2021.08.020.
[14] Chen X, Feng X, Wang M, et al. Laparoscopic versus open distal gastrectomy for advanced gastric cancer: a meta-analysis of randomized controlled trials and high-quality nonrandomized comparative studies[J]. Eur J Surg Oncol, 2020,46(11):1998-2010. DOI: 10.1016/j.ejso.2020.06.046.
[15] Hu Y, Huang C, Sun Y, et al. Morbidity and mortality of laparoscopic versus open D2 distal gastrectomy for advanced gastric cancer: a randomized controlled trial[J]. J Clin Oncol, 2016,34(12):1350-1357. DOI: 10.1200/JCO.2015.63.7215.
[16] Wong J. Effect of laparoscopic vs. open distal gastrectomy on 3-year disease free survival in patients with locally advanced gastric cancer: commentary on the class-01 randomized clinical trial[J]. Transl Gastroenterol Hepatol, 2019,4:78. DOI: 10.21037/tgh.2019.09.14.
[17] 于海涛, 蔡维山, 李世林. 腹腔镜阑尾切除术的学习曲线研究[J].中国医疗前沿,2013,8(4):106,102. DOI: 10.3969/j.issn.1673-5552.2013.04.0074.