Heniford B T, Backus C L, Matthews B D, Greene F L, Teel W B, Sing R F
Department of General Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, P.O. Box 32861, Charlotte, NC 28232, USA.
Am J Surg. 2001 Mar;181(3):226-30. doi: 10.1016/s0002-9610(01)00558-x.
Traditional surgical teaching depends on graduated acquisition of skill learned in residency. The introduction of minimal access techniques after residency training has created a new paradigm dependent on animate course experiences and limited preceptor training. The outcome of performance of a new skill "learned" in these settings has not been assessed. The purpose of this study was to test the benefit of an animate course compared with a precepted operating room experience in learning to perform a laparoscopic splenectomy.
All attending surgeons who had taken a 1-day course to learn laparoscopic splenectomy (n = 37) and those who had undergone an intraoperative preceptorship (in their hospital) by the lead author (n = 15) were polled to ascertain their previous experience with laparoscopy and with laparoscopic splenectomy since the intervention. The course included lectures, operative videos, and an animal lab. Statistical differences were measured using a t test.
Thirty-two of the 37 (86.5%) taking the course and all 15 of the precepted surgeons responded. There was no difference between the groups regarding prior laparoscopic experience (P = 0.73), laparoscopic training during residency (P = 0.74), academic or private practice (P = 0.48), or follow-up since the intervention (P = 0.36). The participants graded the courses (1 to 5, 5 = excellent) at an average of 4.72. Fourteen of 15 precepted surgeons have performed laparoscopic splenectomy as compared with 2 of 32 taking courses (nonprecepted surgeons; P <0.0001). The number of laparoscopic splenectomies performed totaled 112 for precepted surgeons and 4 for nonprecepted surgeons (P = 0.0003). The nonprecepted surgeons performed significantly more open splenectomies than laparoscopic (95 versus 13 respectively, P = 0.02). Reasons quoted not to proceed with laparoscopic splenectomy included waiting for the perfect patient, concern of hilar management, and splenic size.
Surgeons precepted in their own operating room performed a laparoscopic splenectomy more readily than those gaining experience from a course only (93% versus 6%, respectively) despite no difference in their preintervention experience and having the opportunity to do so. The expectation of the eventual performance of advanced laparoscopic techniques depends on a precepted experience.
传统外科教学依赖于住院医师阶段逐步掌握的技能。住院医师培训后引入的微创技术创造了一种新的模式，这种模式依赖于模拟课程体验和有限的带教培训。在这些环境中“学习”的新技能的操作结果尚未得到评估。本研究的目的是测试在学习进行腹腔镜脾切除术时，模拟课程与带教手术室体验相比的益处。
对所有参加过为期1天的腹腔镜脾切除术学习课程的主治外科医生（n = 37）以及那些在其医院接受过主刀作者术中带教的医生（n = 15）进行调查，以确定他们自干预以来在腹腔镜检查和腹腔镜脾切除术方面的既往经验。该课程包括讲座、手术视频和动物实验室。使用t检验测量统计学差异。
37名参加课程的医生中有32名（86.5%）以及所有15名带教医生做出了回应。两组在既往腹腔镜经验（P = 0.73）､住院医师期间的腹腔镜培训（P = 0.74）､学术或私人执业情况（P = 0.48）或干预后的随访情况（P = 0.36）方面没有差异。参与者对课程的评分（1至5分，5分为优秀）平均为4.72分。15名带教医生中有14名进行了腹腔镜脾切除术，而参加课程的32名医生中有2名（非带教医生）进行了该手术（P <0.0001）。带教医生进行的腹腔镜脾切除术总数为112例，非带教医生为4例（P = 0.0003）。非带教医生进行的开放性脾切除术明显多于腹腔镜脾切除术（分别为95例和13例，P = 0.02）。不进行腹腔镜脾切除术的原因包括等待完美的患者、对肝门处理的担忧以及脾脏大小。
尽管在干预前经验无差异且有机会进行腹腔镜脾切除术，但在自己手术室接受带教的外科医生比仅从课程中获得经验的医生更易于进行腹腔镜脾切除术（分别为93%和6%）。对最终掌握先进腹腔镜技术的期望取决于带教经验。
