Lossing A G, Hatswell E M, Gilas T, Reznick R K, Smith L C
Department of Surgery, University of Toronto, Ont.
Can J Surg. 1992 Oct;35(5):536-40.
The proper teaching of operative skills to surgical residents is increasingly constrained by operative time, complex procedures and medicolegal concerns. A technical-skills program was developed and introduced over a 3-year period to 28 1st-year residents in general surgery. To introduce the residents to the principles of surgical techniques in a simulated environment outside the operating room, the program consisted of a combination of two didactic sessions and six "wet labs" taking 3 to 4 hours per week for 8 weeks between January and March each year. The didactic sessions included instruction on suture material and the use of stapling devices; the "wet lab" used a "hands-on" approach. Educational objectives in the "wet lab" included instruction on preparation of the patient and draping, aseptic technique, principles of bowel anastomosis, incisions, instrument use and handling, principles of hemostasis, intraoperative surgical emergencies, surgical assisting and overall conduct in the operating room. The residents' surgical technique and skills improved over the course period. The overall value, teaching and understanding of surgical principles were rated highly. Problems cited during resident feedback were the use of live animals and insufficient time to practise. The efficacy of a surgical-skills program has been demonstrated, but its effectiveness requires further evaluation.
向外科住院医师正确传授手术技能日益受到手术时间、复杂手术程序和法医学问题的限制。我们开发了一项技术技能培训项目，并在3年时间里向28名普通外科一年级住院医师推行。为了让住院医师在手术室之外的模拟环境中了解手术技术原理，该项目包括两个理论教学课程和六个“实操实验室”，每年1月至3月期间，每周进行3至4小时，共持续8周。理论教学课程包括缝线材料和吻合器使用的指导；“实操实验室”采用“动手操作”的方法。“实操实验室”的教育目标包括患者准备和铺巾、无菌技术、肠吻合原则、切口、器械使用和操作、止血原则、术中手术急症、手术辅助以及手术室整体操作规范的指导。在培训期间，住院医师的手术技术和技能得到了提高。手术原则的整体价值、教学效果和理解程度得到了高度评价。住院医师反馈中提到的问题是使用活体动物以及练习时间不足。一项手术技能培训项目的功效已得到证明，但其效果还需要进一步评估。
