Grantcharov Teodor P, Funch-Jensen Peter
University of Toronto, St Michael's Hospital, Toronto, ON, Canada.
Am J Surg. 2009 Apr;197(4):447-9. doi: 10.1016/j.amjsurg.2008.01.024. Epub 2009 Feb 13.
The study was carried out to determine the learning curve patterns for basic laparoscopic technical skills.
Thirty-seven surgical residents with limited laparoscopic experience performed 10 repetitions of 6 tasks on a virtual-reality trainer (MIST-VR) with standardized distribution of practice. Assessment was based on time, errors, and economy of motion as measured by MIST-VR. Proficiency levels were established by testing experienced laparoscopic surgeons.
Four learning curve patterns were determined. Surgeons in group 1 (5.4%) demonstrated proficiency from the beginning; group 2 (70.3%) achieved predefined expert criteria between 2 and 9 repetitions; group 3 (16.2%) demonstrated improvement but was unable to achieve proficiency within 10 repetitions. Group 4 (8.1%) underperformed and showed no tendency of skills improvement, reflecting a group of subjects who probably are unable to learn laparoscopic technique.
The results indicated that a group of subjects could not reach proficiency in the psychomotor skills relevant for laparoscopy. We believe that this is an important issue that should be addressed in future research.
本研究旨在确定基本腹腔镜技术技能的学习曲线模式。
37名腹腔镜经验有限的外科住院医师在虚拟现实训练器（MIST-VR）上对6项任务进行10次重复操作，操作分布标准化。评估基于MIST-VR测量的时间、错误和动作经济性。通过测试经验丰富的腹腔镜外科医生确定熟练水平。
确定了四种学习曲线模式。第1组（5.4%）的外科医生从一开始就表现出熟练；第2组（70.3%）在2至9次重复操作之间达到了预先定义的专家标准；第3组（16.2%）表现出进步，但在10次重复操作内未能达到熟练水平。第4组（8.1%）表现不佳，且未显示技能提高的趋势，这反映出一组可能无法学习腹腔镜技术的受试者。
结果表明，一组受试者无法在与腹腔镜检查相关的心理运动技能方面达到熟练水平。我们认为这是一个重要问题，应在未来研究中加以解决。
