Schell Scott R, Flynn Timothy C
Department of Surgery, University of Florida, Gainesville, Florida 32610-0286, USA.
Curr Surg. 2004 Jan-Feb;61(1):120-4. doi: 10.1016/j.cursur.2003.08.011.
Little published literature describes accurate evaluation and assessment of surgical residents' technical competencies. Work-hour limitations and the proposed changes in training duration challenge our ability to provide core technical competencies, particularly during PGY-1-2. We identified minimally invasive surgery as a particularly challenging competency training area, requiring significant allocation of resident and faculty time and resources, with inconsistent training results. This project evaluated a standardized competency training curriculum in minimally invasive surgery in comparison to existing training.
The Laparoscopy 101-a Resource for Resident Education minimally invasive surgery competency training curriculum consists of CD-ROM-based self-paced didactic self-instruction modules, skills laboratories, and web-based testing, evaluation, and reporting. Five didactic self-study modules and their corresponding web-based examinations were selected for this study. PGY 1-2 residents (11/group) were enrolled. PGY-1 residents received no formal minimally invasive surgery training in our program before participating, whereas PGY-2 residents were exposed to the minimally invasive surgery training program in place in our department. PGY-1 residents completed the training modules and web-based testing over 4 days. PGY-2 residents underwent testing before (pre-test) and after (post-test) completing identical training modules and testing over an identical time period. Test results were examined and compared in both groups. A user-satisfaction survey assessed resident opinions about the quality of the curriculum, use of the CD-ROM/web-based system, and trainee perceptions about performance.
PGY-2 Pre-test scores were equivalent to PGY-1 scores after training (mean overall performance, 52.4% vs 65.5% p = ns). PGY-2 Post-test scores were significantly higher when compared with pre-test scores (mean overall performance; pre: 52.4% vs post: 85.3% p <== 0.001). Interestingly, post-training scores were significantly higher for PGY-2 than PGY-1 (mean overall performance PGY-1: 52.4% vs PGY-2: 65.5% p = ns). Competencies achieved persisted 6 months after initial training in both PGY 1-2 groups without additional training using this curriculum. Overall user satisfaction was positive in each category evaluated.
The Laparoscopy 101 minimally invasive surgery curriculum (1) p;rovides a structured self-paced curriculum for minimally invasive didactic training that is well accepted by trainees; (2) yields PGY-1 competencies equivalent to PGY-2 who receive training in our department's existing program; and (3) yields significant improvement in PGY-2 minimally invasive surgery competencies. Training effects persist to 6 months without reinforcement. Our observations of PGY-2 performance and competency suggest that this training would best be instituted during PGY-2.
已发表的文献中很少有关于对外科住院医师技术能力进行准确评估的描述。工作时间限制以及提议的培训时长变化对我们提供核心技术能力的能力构成了挑战，尤其是在住院医师第一年至第二年期间。我们发现微创手术是一个特别具有挑战性的能力培训领域，需要大量投入住院医师和教员的时间及资源，且培训结果参差不齐。本项目评估了与现有培训相比的标准化微创手术能力培训课程。
《腹腔镜检查101：住院医师教育资源》微创手术能力培训课程包括基于光盘的自主式理论自学模块、技能实验室以及基于网络的测试、评估和报告。本研究选择了五个理论自学模块及其相应的网络考试。招募了住院医师第一年至第二年的学员（每组11人）。住院医师第一年的学员在参与本项目之前在我们的项目中未接受过正式的微创手术培训，而住院医师第二年的学员接触过我们科室现有的微创手术培训项目。住院医师第一年的学员在4天内完成了培训模块和基于网络的测试。住院医师第二年的学员在相同时间段内完成相同的培训模块和测试之前（预测试）和之后（后测试）接受测试。对两组的测试结果进行了检查和比较。一项用户满意度调查评估了学员对课程质量、光盘/基于网络系统的使用以及学员对表现的看法。
住院医师第二年的预测试成绩与住院医师第一年培训后的成绩相当（总体平均成绩，52.4%对65.5%，p值无统计学意义）。住院医师第二年的后测试成绩与预测试成绩相比显著更高（总体平均成绩；预测试：52.4%对后测试：85.3%，p<0.001）。有趣的是，住院医师第二年培训后的成绩显著高于住院医师第一年（总体平均成绩住院医师第一年：52.4%对住院医师第二年：65.5%，p值无统计学意义）。在住院医师第一年至第二年两组中，使用本课程进行初始培训后6个月，所达到的能力无需额外培训仍能持续保持。在评估的每个类别中，总体用户满意度都是积极的。
《腹腔镜检查101》微创手术课程（1）为微创理论培训提供了一个结构化的自主式课程，该课程受到学员的广泛认可；（2）使住院医师第一年的能力等同于在我们科室现有项目中接受培训的住院医师第二年；（3）使住院医师第二年的微创手术能力有显著提高。培训效果在无需强化的情况下持续6个月。我们对住院医师第二年表现和能力的观察表明，这种培训最好在住院医师第二年实施。
