Schijven M P, Schout B M A, Dolmans V E M G, Hendrikx A J M, Broeders I A M J, Borel Rinkes I H M
Department of Surgery, University Medical Center Utrecht, Heidelberglaan 100, PO box 85500, 3508, GA, Utrecht, the Netherlands.
Surg Endosc. 2008 Feb;22(2):472-82. doi: 10.1007/s00464-007-9491-6. Epub 2007 Aug 31.
Specific training in endoscopic skills and procedures has become a necessity for profession with embedded endoscopic techniques in their surgical palette. Previous research indicates endoscopic skills training to be inadequate, both from subjective (resident interviews) and objective (skills measurement) viewpoint. Surprisingly, possible shortcomings in endoscopic resident education have never been measured from the perspective of those individuals responsible for resident training, e.g. the program directors. Therefore, a nation-wide survey was conducted to inventory current endoscopic training initiatives and its possible shortcomings among all program directors of the surgical specialties in the Netherlands.
Program directors for general surgery, orthopaedic surgery, gynaecology and urology were surveyed using a validated 25-item questionnaire.
A total of 113 program directors responded (79%). The respective response percentages were 73.6% for general surgeons, 75% for orthopaedic surgeon, 90.9% for urologists and 68.2% for gynaecologists. According to the findings, 35% of general surgeons were concerned about whether residents are properly skilled endoscopically upon completion of training. Among the respondents, 34.6% were unaware of endoscopic training initiatives. The general and orthopaedic surgeons who were aware of these initiatives estimated the number of training hours to be satisfactory, whereas the urologists and gynaecologists estimated training time to be unsatisfactory. Type and duration of endoscopic skill training appears to be heterogeneous, both within and between the specialties. Program directors all perceive virtual reality simulation to be a highly effective training method, and a multimodality training approach to be key. Respondents agree that endoscopic skills education should ideally be coordinated according to national consensus and guidelines.
A delicate balance exists between training hours and clinical working hours during residency. Primarily, a re-allocation of available training hours, aimed at core-endoscopic basic and advanced procedures, tailored to the needs of the resident and his or her phase of training is in place. The professions need to define which basic and advanced endoscopic procedures are to be trained, by whom, and by what outcome standards. According to the majority of program directors, virtual reality (VR) training needs to be integrated in procedural endoscopic training courses.
对于那些将内镜技术融入其手术技能中的专业而言，内镜技能和操作的专项培训已成为必要。先前的研究表明，从主观（住院医师访谈）和客观（技能评估）角度来看，内镜技能培训都存在不足。令人惊讶的是，内镜住院医师教育中可能存在的缺陷从未从负责住院医师培训的人员，如项目主任的角度进行衡量。因此，在荷兰开展了一项全国性调查，以梳理当前的内镜培训举措及其在所有外科专业项目主任中可能存在的缺陷。
使用一份经过验证的包含25个条目的问卷对普通外科、整形外科、妇科和泌尿外科的项目主任进行调查。
共有113名项目主任回复（79%）。普通外科医生、整形外科医生、泌尿外科医生和妇科医生的回复率分别为73.6%、75%、90.9%和68.2%。根据调查结果，35%的普通外科医生担心住院医师在培训结束时内镜技能是否达标。在受访者中，34.6%的人不知道内镜培训举措。了解这些举措的普通外科医生和整形外科医生认为培训时长令人满意，而泌尿外科医生和妇科医生认为培训时间不令人满意。内镜技能培训的类型和时长在各专业内部和之间似乎都存在差异。项目主任们都认为虚拟现实模拟是一种非常有效的培训方法，多模式培训方法是关键。受访者一致认为，内镜技能教育理想情况下应根据国家共识和指南进行协调。
住院医师培训期间，培训时长与临床工作时长之间存在微妙的平衡。首先，需要重新分配可用的培训时长，针对核心内镜基础和进阶操作，根据住院医师的需求及其培训阶段进行调整。各专业需要明确哪些基础和进阶内镜操作要进行培训、由谁培训以及达到何种结果标准。根据大多数项目主任的看法，虚拟现实（VR）培训需要纳入内镜操作培训课程。
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