Risucci D, Cohen J A., Garbus J E., Goldstein M, Cohen M G.
North Shore University Hospital, Manhasset, New York, USA
Curr Surg. 2001 Mar;58(2):230-235. doi: 10.1016/s0149-7944(00)00425-6.
To assess the effects of practice and dynamic instruction on changes in speed and accuracy during acquisition of simulated laparoscopic surgical skills.Fourteen PGY-1 general surgery residents were randomly assigned to 1 of 2 experimental conditions (n = 7 per group), either practice only or practice with instruction, and required to perform 10 trials of each of 2 laparoscopic surgical skills-cannulation and object passing. Practice only subjects were given verbal instructions for each task, and corrective feedback only after trial 1. Practice with instruction subjects were treated the same, but also saw a videotaped demonstration and received dynamic feedback during and between each trial. Performance speed was recorded for each trial and number of errors was recorded for trials 8 to 10 by videotape review.Mean speed for subjects in both groups increased significantly for both tasks (p < 0.01). Practice with instruction subjects committed significantly fewer errors on object passing (p < 0.04) and were less variable in the number of errors committed during the cannulation task (p < 0.01).Practice, with or without dynamic instruction, results in significant improvement in the speed of performance of simulated laparoscopic surgical skills. The addition of dynamic instruction to simulator-based practice improves the quality and consistency of resident acquisition of laparoscopic surgical skills.
评估练习和动态指导对模拟腹腔镜手术技能习得过程中速度和准确性变化的影响。14名一年级普通外科住院医师被随机分配到2种实验条件中的1种（每组n = 7），即仅练习或练习加指导，并要求对2种腹腔镜手术技能——套管插入术和物体传递术各进行10次试验。仅练习组的受试者每项任务都接受了口头指导，且仅在第1次试验后接受纠正性反馈。练习加指导组的受试者接受相同的口头指导，但还观看了录像示范，并在每次试验期间和试验之间接受动态反馈。通过录像回顾记录每次试验的执行速度，并记录第8至10次试验的错误数量。两组受试者在两项任务中的平均速度均显著提高（p < 0.01）。练习加指导组的受试者在物体传递任务中的错误显著减少（p < 0.04），并且在套管插入任务中犯错误的数量变化较小（p < 0.01）。无论有无动态指导，练习都会使模拟腹腔镜手术技能的执行速度显著提高。在基于模拟器的练习中增加动态指导可提高住院医师腹腔镜手术技能习得的质量和一致性。
