What impact does a specialized center for transplantation and heptobiliary disease have on post-graduate resident training of gastroenterologists and surgeons?

摘要

What impact does a specialized center for Hepatobiliary disease and transplantation have on the training of general Gastroenterologists and Surgeons? Currently, the postgraduate medical training environment in the United States is in tremendous evolution. Many changes are already common practice in the European community. In July 2003, guidelines regarding trainee work-hours and programmatic curricular topics became requirements for continued accreditation by the Accreditation Council for Graduate Medical Education (ACGME) in the United States. In order to ensure efficient resident education and compliance with work-hour guidelines, trainee clinical rotations are assigned more for the educational value of the clinical experience versus 'service' requirements for house staff. Due to limited work hours, training programs must now be meticulously organized in order to cover mandatory topics in a shorter time period. More burden is being placed on the house officer to supplement his or her clinical exposure with independent study and readings when not in the hospital . Traditional models of immersion learning in academic medical centers, where large volumes of patients are cared for, is being re-examined. The current trend in post-graduate residency training is to expose the trainee to broad-based clinical training with limited numbers of patients which often leaves the trainee ill-equipped to handle intricate and complicated disease states in an individual patient. With the increasing technological advances, sophistication of anti-Hepatitis therapy and complexity of patients with liver disease requiring operative and/or medical interventions, specialized Transplant/Hepatobiliary centers, or disease specific centers, are alternatives to care for these types of patients. Other specialties such as Cardiology and Cardiac Surgery, Neurology, Orthopedics and Ophthalmology have established specialized free-standing hospitals or disease specific centers within traditional academic medical settings with demonstrable improvement in efficiency in patientcare, improvement in patient outcomes and focused residency training [3-5]. Unlike Ophthalmology, Orthopedics and Neurology, however, Transplant/Hepatobiliary surgery and Hepatology are post-residency fellowships and do not have their own designated residency-training programs. The question arises if care of the complicated liver patient is designated to specialized centers or free standing specialty hospitals, how will this affect the training of General Surgery Residents as well as the General Gastroenterology fellow vs. the Transplant Surgery and the Hepatology fellows? First, let us review what are the current requirements for accreditation for General Surgery residents; Gastroenterology fellows versus the Transplant Surgery/Hepatologist in transplant related fields of study in the United States and Canada.