Immenroth Marc, Bürger Thomas, Brenner Jürgen, Nagelschmidt Manfred, Eberspächer Hans, Troidl Hans
Ethicon, Endo-Surgery Europe, Norderstedt, Germany.
Ann Surg. 2007 Mar;245(3):385-91. doi: 10.1097/01.sla.0000251575.95171.b3.
To evaluate the impact of a cognitive training method on the performance of simulated laparoscopic cholecystectomy in laparoscopic training courses.
Surgeons are like professional sportsmen in that they have to be able to perform complicated, fine-motor movements under stressful conditions. Mental training, systematically and repeatedly imagining a movement's performance, is a well-established technique in sports science, and this study aimed to determine its value in training surgeons.
A total of 98 surgeons undergoing basic laparoscopic training participated in a randomized controlled trial; 31 received additional mental training, 32 additional practical training, and 35 received no additional training (control group). All used a Pelvi-Trainer simulator to perform laparoscopic cholecystectomy at baseline and follow-up, after any additional intervention. We used a modified Objective Structured Assessment of Technical Skills (OSATS) instrument to assess performance. Principle outcome variables were the OSATS task-specific checklist (11 procedural steps, scored as correctly [1] or wrongly [0] performed) and the global rating scale (an overall performance evaluation, scored 1-5).
Improvement in the task-specific checklist score between baseline and follow-up differed significantly between groups (P = 0.046 on ANOVA). Least significant difference tests yielded differences between the mental and practical training groups (P = 0.024) and between the mental training and control groups (P = 0.040), but not between the practical training and control groups (P = 0.789). Paired Student t test showed that performance at follow-up was significantly better in the mental training and control groups (mental training group, P = 0.001; control group, P = 0.018) but not the practical training group (P = 0.342). There were no significant intergroup differences in global rating scale results.
Additional mental training is an effective way of optimizing the outcomes of further training for laparoscopic cholecystectomy. It is associated with fewer costs and with better outcomes in some crucial assessment scales than additional practical training.
评估一种认知训练方法对腹腔镜培训课程中模拟腹腔镜胆囊切除术操作表现的影响。
外科医生如同职业运动员，必须能够在压力环境下执行复杂的精细运动。心理训练，即系统且反复地想象动作的执行过程，是体育科学中一项成熟的技术，本研究旨在确定其在培训外科医生方面的价值。
共有98名接受基础腹腔镜培训的外科医生参与了一项随机对照试验；31人接受额外的心理训练，32人接受额外的实践训练，35人未接受额外训练（对照组）。所有人在基线期及任何额外干预后的随访期，使用骨盆训练模拟器进行腹腔镜胆囊切除术。我们使用改良的客观结构化技术技能评估（OSATS）工具来评估操作表现。主要结局变量为OSATS特定任务清单（11个操作步骤，执行正确计为[1]，错误计为[0]）和整体评分量表（整体操作表现评估，评分1 - 5）。
基线期与随访期之间特定任务清单评分的改善在各组间存在显著差异（方差分析，P = 0.046）。最小显著差异检验显示心理训练组与实践训练组之间存在差异（P = 0.024），心理训练组与对照组之间存在差异（P = 0.040），但实践训练组与对照组之间无差异（P = 0.789）。配对学生t检验显示，随访期心理训练组和对照组的操作表现显著更好（心理训练组，P = 0.001；对照组，P = 0.018），但实践训练组无显著差异（P = 0.342）。整体评分量表结果在组间无显著差异。
额外的心理训练是优化腹腔镜胆囊切除术进一步培训效果的有效方法。与额外的实践训练相比，它成本更低，且在一些关键评估量表上效果更好。
