Hogle N J, Chang L, Strong V E M, Welcome A O U, Sinaan M, Bailey R, Fowler D L
Department of Surgery, College of Physicians and Surgeons, Columbia University, New York, NY 10032, USA.
Surg Endosc. 2009 Jul;23(7):1476-82. doi: 10.1007/s00464-009-0379-5. Epub 2009 Mar 5.
Surgical skills training outside the operating room is beneficial. The best methods have yet to be identified. The authors aimed to document the predictive validity of simulation training in three different studies.
Study 1 was a prospective, randomized, multicenter trial comparing performance in the operating room after training on a laparoscopic simulator and after no training. The Global Operative Assessment of Laparoscopic Skills (GOALS) was used to evaluate operative performance. Study 2 retrospectively reviewed the operative performance of junior residents before and after implementation of a laparoscopic skills training curriculum. Operative time was the variable used to determine resident improvement. Study 3 was a prospective, randomized trial evaluating intern operative performance of laparoscopic cholecystectomy in a porcine model before and after training on a simulator. Operative performance was assessed using GOALS.
All three studies failed to demonstrate predictive validity. With GOALS used as the assessment tool, no difference was found between trained and untrained residents in studies 1 and 3. In study 2, the trained group took significantly longer to complete a laparoscopic cholecystectomy than the untrained group.
No correlation was found between the three types of training outside the operating room, and no improved operative performance was observed. Possible explanations include too few subjects, training introduced too late in the learning curve, and training criteria that were too easy. Additionally, simulator training focuses on precision, which may actually increase task time. Awareness of these issues can improve the design of future studies.
手术室之外的外科技能培训是有益的。最佳方法尚未确定。作者旨在通过三项不同研究记录模拟培训的预测效度。
研究1是一项前瞻性、随机、多中心试验，比较在腹腔镜模拟器上培训后与未培训后在手术室中的操作表现。使用腹腔镜技能全球手术评估（GOALS）来评估手术操作。研究2回顾性分析了腹腔镜技能培训课程实施前后初级住院医师的手术操作。手术时间是用于确定住院医师进步情况的变量。研究3是一项前瞻性、随机试验，评估在模拟器上培训前后猪模型中实习生腹腔镜胆囊切除术的手术操作。使用GOALS评估手术操作。
所有三项研究均未证明预测效度。在研究1和3中，以GOALS作为评估工具，未发现培训组和未培训组住院医师之间存在差异。在研究2中，培训组完成腹腔镜胆囊切除术的时间明显长于未培训组。
未发现三种手术室之外的培训类型之间存在相关性，也未观察到手术操作表现有所改善。可能的解释包括受试者过少、在学习曲线中培训引入过晚以及培训标准过于简单。此外，模拟器培训注重精准度，这实际上可能会增加任务时间。认识到这些问题有助于改进未来研究的设计。
