Nousiainen Markku, Brydges Ryan, Backstein David, Dubrowski Adam
Department of Surgery and the Wilson Centre for Research in Education, University of Toronto, Faculty of Medicine, Toronto, Ontario, Canada.
Surgery. 2008 Apr;143(4):539-44. doi: 10.1016/j.surg.2007.10.022. Epub 2008 Jan 30.
Practice using computer-based video instruction (CBVI) leads to improvements in surgical skills proficiency. This study investigated the benefits of the introduction of (a) learner-directed, interactive video training and (b) the addition of expert instruction on the learning and retention of the basic surgical skills of suturing and knot-tying in medical students.
Using bench models, students were pre-tested on a suturing and knot-tying skill after viewing an instructional video. The students were then randomly assigned to three practice conditions: self-study with video; self-study with interactive video; or the combination of self-study with interactive video with the addition of subsequent expert instruction. All participants underwent 18 trials of practice in their assigned training condition. The effectiveness of training was assessed by an immediate post-test and a retention test one month later. Performance was evaluated using expert- and computer-based assessments. Data were analyzed using repeated-measures ANOVA.
There were no differences in expert- and computer-based assessments between groups at pre-test. Although all three groups demonstrated significant improvements on both measures between the pre- and post-tests as well as between pre-tests and retention-tests (P < .01), no significant differences were detected among the three groups.
This study shows that in surgical novices, neither the inclusion of expert instruction nor the addition of self-directed interaction with video leads to further improvements in skill development or retention. These findings further support the possible implementation of CBVI within surgical skills curricula.
运用基于计算机的视频教学(CBVI)进行练习可提高手术技能的熟练程度。本研究调查了引入(a)以学习者为导向的交互式视频训练和(b)增加专家指导对医学生缝合和打结等基本手术技能学习及保持的益处。
使用实验台模型,学生在观看教学视频后对缝合和打结技能进行预测试。然后将学生随机分配到三种练习条件下:观看视频自学;观看交互式视频自学;或观看交互式视频自学并随后增加专家指导。所有参与者在其指定的训练条件下进行18次练习试验。通过即时后测和一个月后的保持测试来评估训练效果。使用专家评估和基于计算机的评估来评价表现。数据采用重复测量方差分析进行分析。
预测试时,各小组在专家评估和基于计算机的评估方面无差异。尽管所有三个小组在预测试与后测试之间以及预测试与保持测试之间在这两项测量上均显示出显著改善(P < .01),但三组之间未检测到显著差异。
本研究表明,对于外科新手而言,无论是纳入专家指导还是增加与视频的自主交互,均不会导致技能发展或保持方面的进一步改善。这些发现进一步支持了在手术技能课程中可能实施CBVI。