Sarker Sudip K, Rehman Saif, Ladwa Meera, Chang Avril, Vincent Charles
University Department of Surgery, Royal Free Hospital, London, UK.
Surg Endosc. 2009 Jan;23(1):197-203. doi: 10.1007/s00464-008-9774-6. Epub 2008 Mar 5.
Making correct decisions is an integral part of surgical competency and excellence. The learning of this expert skill takes years to accumulate during training. To date there has not been an attempt to accelerate this learning process by developing a tool. In our present study we develop a self-appraisal computer software learning and assessment decision-making tool for laparoscopic surgery. It aims to accumulate several years of varied surgical experience, so the trainee can start to learn the complexities of surgical decision making in various types of cases. In this study we aim to validate the tool.
Three decision-making modules were developed in a computer program for laparoscopic cholecystectomy: knowledge of operation, operative surgical technique and operative task completion. The latter two modules were based on answering questions based on watching recorded live operations from a library of 100 recorded laparoscopic cholecystectomies of various grades. The questions were devised by two experienced surgeons with more than 14 years postgraduate surgical experience. To validate the tool two groups with varying surgical experience were assessed: intermediate and expert surgeons. These groups were determined by the number of laparoscopic cholecystectomies performed as well as of number of years of operative surgical experience.
A total of 20 subjects were assessed, 12 intermediate and 8 experts surgeons. Mean time to perform the programme was 21 min (range 18-45 min). Using the Mann-Whitney test, p < 0.05, construct validity was demonstrated in the surgical technique and completion of task modules as well as the total combined scores.
Our computer-based decision-making learning tool for laparoscopic cholecystectomy seems to have face, content, concurrent and construct validities. Surgical decision making is a multifaceted process; by assessing how and why decisions are made effectively, focussed surgical training may be achieved. We aim in the future to determine if the self-appraisal decision-making tool improves or accelerates surgical training.
做出正确决策是手术能力与卓越表现的一个重要组成部分。在培训过程中，掌握这项专业技能需要数年时间来积累。迄今为止，尚未有人尝试通过开发一种工具来加速这一学习过程。在我们目前的研究中，我们开发了一种用于腹腔镜手术的自我评估计算机软件学习与评估决策工具。其目的是积累数年多样的手术经验，以便实习生能够开始学习各类病例中手术决策的复杂性。在本研究中，我们旨在验证该工具。
针对腹腔镜胆囊切除术在计算机程序中开发了三个决策模块：手术知识、手术操作技术和手术任务完成情况。后两个模块基于观看从100例不同级别腹腔镜胆囊切除术录像库中选取的现场手术录像来回答问题。这些问题由两位具有超过14年外科研究生手术经验的资深外科医生设计。为验证该工具，对两组具有不同手术经验的人员进行了评估：中级和专家级外科医生。这些组别根据所实施的腹腔镜胆囊切除术数量以及手术经验年限来确定。
总共评估了20名受试者，其中12名中级外科医生和8名专家级外科医生。完成该程序的平均时间为21分钟（范围18 - 45分钟）。使用曼 - 惠特尼检验，p < 0.05，在手术技术、任务完成模块以及总分组合分数方面均证明了结构效度。
我们基于计算机的腹腔镜胆囊切除术决策学习工具似乎具有表面效度、内容效度、同时效度和结构效度。手术决策是一个多方面的过程；通过评估决策如何以及为何有效做出，可实现有针对性的外科培训。我们未来旨在确定自我评估决策工具是否能改善或加速外科培训。
