Sutherland Leanne M, Middleton Philippa F, Anthony Adrian, Hamdorf Jeffrey, Cregan Patrick, Scott David, Maddern Guy J
ASERNIP-S, Royal Australasian College of Surgeons, Stepney, South Australia, Australia.
Ann Surg. 2006 Mar;243(3):291-300. doi: 10.1097/01.sla.0000200839.93965.26.
To evaluate the effectiveness of surgical simulation compared with other methods of surgical training.
Surgical simulation (with or without computers) is attractive because it avoids the use of patients for skills practice and provides relevant technical training for trainees before they operate on humans.
Studies were identified through searches of MEDLINE, EMBASE, the Cochrane Library, and other databases until April 2005. Included studies must have been randomized controlled trials (RCTs) assessing any training technique using at least some elements of surgical simulation, which reported measures of surgical task performance.
Thirty RCTs with 760 participants were able to be included, although the quality of the RCTs was often poor. Computer simulation generally showed better results than no training at all (and than physical trainer/model training in one RCT), but was not convincingly superior to standard training (such as surgical drills) or video simulation (particularly when assessed by operative performance). Video simulation did not show consistently better results than groups with no training at all, and there were not enough data to determine if video simulation was better than standard training or the use of models. Model simulation may have been better than standard training, and cadaver training may have been better than model training.
While there may be compelling reasons to reduce reliance on patients, cadavers, and animals for surgical training, none of the methods of simulated training has yet been shown to be better than other forms of surgical training.
评估手术模拟与其他手术训练方法相比的有效性。
手术模拟（无论有无计算机辅助）具有吸引力，因为它避免了在技能练习中使用患者，并在学员对人体进行手术前为其提供相关技术培训。
通过检索MEDLINE、EMBASE、Cochrane图书馆及其他数据库，直至2005年4月来确定研究。纳入的研究必须是随机对照试验（RCT），评估任何使用至少某些手术模拟元素的训练技术，并报告手术任务表现的测量指标。
尽管RCT的质量通常较差，但仍有30项RCT（涉及760名参与者）能够被纳入。计算机模拟总体上显示出比完全不训练（以及在一项RCT中比实体训练器/模型训练）更好的结果，但并不明显优于标准训练（如手术演练）或视频模拟（尤其是通过手术表现评估时）。视频模拟并不总是显示出比完全不训练的组更好的结果，且没有足够数据来确定视频模拟是否优于标准训练或模型使用。模型模拟可能优于标准训练，尸体训练可能优于模型训练。
虽然可能有令人信服的理由减少在手术训练中对患者、尸体和动物的依赖，但尚未证明任何模拟训练方法比其他形式的手术训练更好。
