Van Hove Corey, Perry Kyle A, Spight Donn H, Wheeler-Mcinvaille Krissy, Diggs Brian S, Sheppard Brett C, Jobe Blair A, O'Rourke Robert W
Department of Surgery, Oregon Health & Science University Portland, 3181 SW Sam Jackson Park Road, L-223A, Portland, OR 97239-3098, USA.
World J Surg. 2008 Sep;32(9):1917-21. doi: 10.1007/s00268-008-9643-4.
Administrative and financial pressures on surgical education have created a need for efficient training curricula. Predictors of innate technical ability, which would guide the optimization of such a curriculum, are not well described. The goal of this study was to identify student characteristics predictive of innate pretraining skill level and response to training during the course of a four-week laparoscopic skills development program.
Laparoscopic skills in 35 first-year surgical residents were assessed with the McGill Inanimate System for Training and Evaluation of Laparoscopic Skills (MISTELS) before and after a four-week skills training program and after an interval of approximately 1 year. The correlation between trainee characteristics, including age, sex, designated surgical specialty, and laparoscopic skill level was assessed by using Pearson's correlation and paired t-test studies.
Intake MISTELS scores showed no significant correlation to age, sex, or designated field. Interns designated for the general surgery training program had significantly higher final scores than those entering other fields (p = 0.02). There was a negative correlation between trainee age and both degree of improvement during training and final scores (p = 0.02 and 0.05). A history of video game use correlated with significantly higher initial scores and better skills retention (p = 0.03 and 0.04).
A laparoscopic technical curriculum can achieve basic proficiency even when taught to a diverse group of trainees. Older residents beginning their surgical careers may be slower to develop technical skills. Choice of subspecialty seems to predict higher level of proficiency after completion of a skills training program among resident students.
外科教育面临的行政和财务压力促使人们需要高效的培训课程。然而，对于能够指导此类课程优化的先天技术能力预测因素，目前尚无详尽描述。本研究的目的是确定在为期四周的腹腔镜技能发展计划过程中，能够预测先天预训练技能水平以及对培训反应的学生特征。
在为期四周的技能培训计划前后以及大约一年的间隔期后，使用麦吉尔腹腔镜技能训练与评估无生命系统（MISTELS）对35名一年级外科住院医师的腹腔镜技能进行评估。通过Pearson相关性分析和配对t检验研究，评估包括年龄、性别、指定外科专业和腹腔镜技能水平在内的学员特征之间的相关性。
入学时的MISTELS分数与年龄、性别或指定领域均无显著相关性。指定参加普通外科培训计划的实习生最终得分显著高于进入其他领域的实习生（p = 0.02）。学员年龄与培训期间的进步程度及最终得分均呈负相关（p = 0.02和0.05）。有电子游戏使用史与显著更高的初始分数及更好的技能保持相关（p = 0.03和0.04）。
即使针对不同类型的学员开展腹腔镜技术课程教学，也能实现基本熟练程度。刚开始外科职业生涯的年长住院医师可能技术技能发展较慢。在住院医学生完成技能培训计划后，亚专业的选择似乎预示着更高的熟练水平。
