Carter Yvonne M, Marshall M Blair
Division of Thoracic Surgery, Georgetown University Medical Center, Washington, DC 20007, USA.
Ann Thorac Surg. 2009 May;87(5):1546-50; discussion 1551. doi: 10.1016/j.athoracsur.2009.02.022.
Simulation has long been appreciated and used in professional industry training. The effectiveness of high-fidelity, low-cost simulators in such settings has led to its integration into surgical education for skill development. Simulation may possibly have a role in surgical specialty training.
Replicas of a human torso with a posterolateral thoracotomy incision were constructed from poultry netting and casting fiberglass, and used to house a previously prepared bovine lung. After reviewing computerized instructional material, student volunteers were asked to perform a lobectomy with the assistance of a thoracic surgeon, who also evaluated the subjects. Objective data were collected from knowledge-based examinations and technical skills evaluation scales. Statistical analysis was performed with the Student's t test.
The initial success rate was 88.9% (16 of 18). Significant improvements were appreciated in both subjective and objective measures by the third week with weekly repetition. The average operative time was reduced to 34.8 +/- 5 minutes from 48.5 +/- 4.9 minutes (p = 0.01). The average task-specific score was 7.8 +/- 0.8 (versus 5.6 +/- 2.1; p = 0.05), and students achieved an average global performance score of 28.6 +/- 3.8 (p = 0.01). Scores on knowledge-based examinations also significantly improved.
This open lobectomy simulation can be used to effectively teach thoracic surgery techniques. Our results prove the effectiveness of simulation training in thoracic surgery. Additional studies will determine whether simulation is effective for different training levels in thoracic surgery.
模拟技术长期以来一直受到专业行业培训的重视和应用。高保真、低成本模拟器在这类环境中的有效性促使其被纳入外科教育以促进技能发展。模拟可能在外科学专科培训中发挥作用。
用家禽网和玻璃纤维铸件制作带有后外侧开胸切口的人体躯干复制品，并用于容纳预先准备好的牛肺。在查看计算机化教学材料后，学生志愿者在胸外科医生的协助下进行肺叶切除术，胸外科医生也对受试者进行评估。从基于知识的考试和技术技能评估量表中收集客观数据。采用学生t检验进行统计分析。
初始成功率为88.9%（18例中的16例）。通过每周重复，到第三周时主观和客观指标均有显著改善。平均手术时间从48.5±4.9分钟降至34.8±5分钟（p = 0.01）。平均特定任务得分为7.8±0.8（相比之下为5.6±2.1；p = 0.05），学生的平均整体表现得分为28.6±3.8（p = 0.01）。基于知识的考试成绩也显著提高。
这种开放性肺叶切除模拟可用于有效教授胸外科技术。我们的结果证明了模拟训练在胸外科中的有效性。更多研究将确定模拟对于胸外科不同培训水平是否有效。
