Fried Gerald M
Department of Surgery, McGill University, McGill University Health Center, 1650 Cedar Avenue, #L9-309, Montreal, Quebec H3G 1A4, Canada.
Gastrointest Endosc Clin N Am. 2006 Jul;16(3):425-34. doi: 10.1016/j.giec.2006.03.009.
Simulation technology in laparoscopic surgery has developed in response to a need to teach fundamental surgical skills in a safe environment. The skill set needed was defined carefully according to the classic educational model of needs assessment. Once defined, the skills were modeled in a simulator. The recognition that a simulator need not have high fidelity to achieve significant educational value was important in keeping costs reasonably low. Intrinsic to an effective simulation program is a set of metrics or measurements of performance. These metrics provide motivation for the student and allow comparison among students. Once shown to be reliable and valid, the simulator metrics can be used to set reasonable goals and standards for certification. Although simulators permit verification of learning, point simulation testing cannot by itself be used at present to ensure competence. Until the predictive value of these tests has been validated further, competence still needs to be determined by expert assessment of observed performance in real cases and by measurable outcome variables from real procedures. Simulation training is most beneficial when incorporated into a curriculum that teaches the accompanying knowledge and judgment essential for safe practice of the skills taught in the simulator. The FLS program distributed by the Society of American Gastrointestinal and Endoscopic Surgeons and the American College of Surgeons is an example of a carefully planned and validated program that incorporates these principles in laparoscopic surgery education. The lessons learned from development of the FLS program can be useful in designing a similar program for flexible gastrointestinal endoscopy.
腹腔镜手术模拟技术是为满足在安全环境中教授基本手术技能的需求而发展起来的。所需的技能集是根据需求评估的经典教育模式精心定义的。一旦确定，这些技能就在模拟器中建模。认识到模拟器不一定需要高保真度就能实现显著的教育价值，这对于将成本保持在合理低水平很重要。有效的模拟程序的内在要素是一组性能指标或测量方法。这些指标为学生提供动力，并允许在学生之间进行比较。一旦被证明是可靠和有效的，模拟器指标就可用于设定合理的认证目标和标准。虽然模拟器允许对学习进行验证，但目前仅凭点模拟测试本身不能用于确保能力。在这些测试的预测价值得到进一步验证之前，能力仍需通过对实际病例中观察到的表现进行专家评估以及通过实际手术的可测量结果变量来确定。当模拟训练纳入一门课程中，该课程教授与模拟器中所教授技能的安全实践必不可少的相关知识和判断力时，模拟训练最为有益。美国胃肠与内镜外科医师协会和美国外科医师学会发布的FLS计划就是一个精心规划和验证的计划的例子，该计划将这些原则纳入腹腔镜手术教育中。从FLS计划的开发中吸取的经验教训可能有助于设计一个类似的灵活胃肠内镜检查计划。
