Boehler Margaret L, Schwind Cathy J, Rogers David A, Ketchum Janet, O'Sullivan Erin, Mayforth Ruth, Quin Jacquelyn, Wohltman Chris, Johnson Colleen, Williams Reed G, Dunnington Gary
Department of Surgery, Southern Illinois University School of Medicine, Springfield, IL 62794-9655, USA.
J Am Coll Surg. 2007 Sep;205(3):492-7. doi: 10.1016/j.jamcollsurg.2007.04.018. Epub 2007 Jul 16.
Curricula for surgical technical skills laboratories have traditionally been designed to accommodate the clinical activities of residents, so they typically consist of individual, episodic training sessions. We believe that the skills laboratory offers an opportunity to design a surgical skills curriculum based on the fundamental elements known to be important for motor skill instruction. We hypothesized that training novices with such a curriculum for a 1-month period would yield skills performance levels equivalent to those of second year surgery residents who had trained in a traditional program.
Fourth-year medical students served as study subjects (novice group) during a 4-week senior elective. They were taught each skill during a 1-week period. Subjects received instruction by a content expert followed by a 1-week period of deliberate practice with feedback. The novice performances were videotaped both before and after the intervention, and each videotape was evaluated in a blinded fashion by experts using a validated evaluation instrument. These results were compared with skill performance ratings of first- and second-year surgery residents that had been accumulated over the previous 3 years.
Average performance ratings for the novices substantially improved for all four skills after training. There was no marked difference between average performance ratings of postintervention novice scores when compared with the average scores in the resident group. Inter-rater agreement in scoring for the videotaped novice performances exceeded 0.87 (intraclass correlation) for all ratings of pre- and posttraining.
These results demonstrate the effectiveness of a laboratory-based training program that includes fundamentals of motor skills acquisition.
外科技术技能实验室的课程传统上是为适应住院医师的临床活动而设计的，所以通常由单独的、阶段性的培训课程组成。我们认为技能实验室提供了一个机会，可以根据已知对运动技能教学很重要的基本要素来设计外科技能课程。我们假设用这样一个课程对新手进行为期1个月的培训，其技能表现水平将等同于在传统课程中接受培训的二年级外科住院医师。
四年级医学生在为期4周的高级选修课期间作为研究对象（新手组）。他们在1周的时间里学习每项技能。受试者先由一位内容专家授课，然后进行为期1周的有反馈的刻意练习。在干预前后对新手的表现进行录像，每段录像由专家使用经过验证的评估工具以盲法进行评估。将这些结果与前3年积累的一年级和二年级外科住院医师的技能表现评分进行比较。
培训后，新手在所有四项技能上的平均表现评分都有显著提高。与住院医师组的平均分数相比，干预后新手分数的平均表现评分没有明显差异。对于培训前和培训后的所有评分，录像新手表现评分的评分者间一致性超过0.87（组内相关）。
这些结果证明了一个基于实验室的培训项目的有效性，该项目包括运动技能习得的基本要素。
