Wentink M, Stassen L P S, Alwayn I, Hosman R J A W, Stassen H G
Delft University of Technology, Faculty OCP, Section Man-Machine Systems, Mekelweg 2, 2628 CD, Delft, The Netherlands.
Surg Endosc. 2003 Aug;17(8):1241-6. doi: 10.1007/s00464-002-9140-z. Epub 2003 Jun 13.
Compared to aviation, where virtual reality (VR) training has been standardized and simulators have proven their benefits, the objectives, needs, and means of VR training in minimally invasive surgery (MIS) still have to be established. The aim of the study presented is to introduce Rasmussen's model of human behavior as a practical framework for the definition of the training objectives, needs, and means in MIS.
Rasmussen distinguishes three levels of human behavior: skill-, rule-, and knowledge-based behaviour. The training needs of a laparoscopic novice can be determined by identifying the specific skill-, rule-, and knowledge-based behavior that is required for performing safe laparoscopy. Future objectives of VR laparoscopy trainers should address all three levels of behavior.
Although most commercially available simulators for laparoscopy aim at training skill-based behavior, especially the training of knowledge-based behavior during complications in surgery will improve safety levels. However, the cost and complexity of a training means increases when the training objectives proceed from the training of skill-based behavior to the training of complex knowledge-based behavior.
In aviation, human behavior models have been used successfully to integrate the training of skill-, rule-, and knowledge-based behavior in a full flight simulator. Understanding surgeon behavior is one of the first steps towards a future full-scale laparoscopy simulator.
与虚拟现实（VR）训练已实现标准化且模拟器已证明其益处的航空领域相比，微创手术（MIS）中VR训练的目标、需求和方法仍有待确立。本研究的目的是引入拉斯穆森的人类行为模型，作为定义MIS训练目标、需求和方法的实用框架。
拉斯穆森区分了人类行为的三个层次：基于技能、基于规则和基于知识的行为。腹腔镜新手的训练需求可通过确定安全进行腹腔镜检查所需的特定基于技能、基于规则和基于知识的行为来确定。VR腹腔镜训练器的未来目标应涵盖所有三个行为层次。
尽管大多数市售的腹腔镜模拟器旨在训练基于技能的行为，但尤其是在手术并发症期间对基于知识的行为进行训练将提高安全水平。然而，当训练目标从基于技能的行为训练转向复杂的基于知识的行为训练时，训练手段的成本和复杂性会增加。
在航空领域，人类行为模型已成功用于在全飞行模拟器中整合基于技能、基于规则和基于知识的行为训练。理解外科医生的行为是迈向未来全尺寸腹腔镜模拟器的首要步骤之一。
