Jensen Aaron R, Wright Andrew S, McIntyre Lisa K, Levy Adam E, Foy Hugh M, Anastakis Dimitri J, Pellegrini Carlos A, Horvath Karen D
Department of Surgery, Room BB-487, University of Washington, 1959 NE Pacific St, Box 356410, Seattle, WA 98195, USA.
Arch Surg. 2008 Sep;143(9):852-8; discussion 858-9. doi: 10.1001/archsurg.143.9.852.
Multimedia delivery of cognitive content paired with faculty-supervised partial task simulation for both excision of a simulated skin lesion with subsequent wound closure and hand-sewn bowel anastomosis would be an effective method for developing appropriate procedural skills among junior residents.
Prospective cohort study.
University-based surgical residency.
First- and second-year surgical residents (n = 45).
Surgical residents were given comprehensive instructional materials, including structured curricula with goals and objectives, text, figures, and narrated expert digital video, before the training session. A 4-hour, standardized, laboratory-based instruction session was then performed in small groups, which emphasized faculty-supervised practice. Residents were asked to (1) excise a skin lesion and close the wound and (2) perform hand-sewn bowel anastomosis. These 2 tasks were assessed before and after supervised practice. Performances were video recorded. Residents were surveyed before and after training.
Time to completion and Objective Structured Assessment of Technical Skill global rating scale score based on video recordings were evaluated by blinded reviewers. Final product quality was measured by anastomotic leak pressure and by wound closure aesthetic quality.
Residents perceived the laboratory training to be equal to training in the operating room for skin closure and superior to training in the operating room for bowel anastomosis. Residents perceived time spent on both tasks to be "perfect." Mean objective scores improved significantly on 5 of 6 outcome measures.
Junior resident surgical performance improved substantially with 4 hours of laboratory-based, faculty-supervised practice. Both first- and second-year residents benefited from this training. These data show that curriculum-driven, faculty-supervised instruction in a laboratory setting is beneficial in the training of junior surgical residents.
将认知内容的多媒体交付与教员监督下的部分任务模拟相结合，用于模拟皮肤病变切除及后续伤口缝合和手工缝合肠道吻合术，这将是一种培养初级住院医师适当操作技能的有效方法。
前瞻性队列研究。
大学附属医院外科住院医师培训项目。
第一年和第二年的外科住院医师（n = 45）。
在培训课程前，为外科住院医师提供了全面的教学材料，包括带有目标和目的的结构化课程、文本、图表以及配有旁白的专家数字视频。然后以小组形式进行了为期4小时的标准化实验室教学，重点是教员监督下的实践。要求住院医师（1）切除皮肤病变并缝合伤口，（2）进行手工缝合肠道吻合术。在监督实践前后对这两项任务进行评估。操作过程进行录像。在培训前后对住院医师进行调查。
由不知情的评审人员根据录像评估完成时间和基于客观结构化技术技能评估的整体评分量表得分。通过吻合口漏压力和伤口缝合美观质量来衡量最终产品质量。
住院医师认为实验室培训在皮肤缝合方面等同于手术室培训，在肠道吻合术方面优于手术室培训。住院医师认为在这两项任务上花费的时间“恰到好处”。在6项观察指标中的5项上，平均客观得分显著提高。
通过4小时基于实验室的、教员监督下的实践，初级住院医师的手术操作表现有了显著改善。第一年和第二年的住院医师都从这种培训中受益。这些数据表明，在实验室环境中进行课程驱动、教员监督的教学对初级外科住院医师的培训是有益的。
