Centre for Surgical Technologies, Leuven, Belgium.
Surg Endosc. 2009 Dec;23(12):2755-61. doi: 10.1007/s00464-009-0498-z. Epub 2009 May 15.
Because of the complex nature of laparoscopic suturing, numerous curricula have been developed to overcome the steep learning curve in a patient-free environment. Distributed training leads to better acquisition and retention of skill compared with massed training. However, this requires considerable time commitment of experts that supervise these training sessions. This study investigates the possibility of replacing expert supervision by structured training with video demonstrations and peer feedback.
The study population consisted of two balanced groups of ten senior medical students with minimal experience in laparoscopy. The control group trained with continuous expert feedback while for the experimental group only video demonstrations and external feedback from peers were available. Training was completed when a previously determined expert level was achieved on two consecutive attempts (proficiency criterion). Students were tested on their suturing skills 1 week after the training as well as after 4 months. A composite score assessing quality and quantity of suturing performance was used. Data are shown as median (interquartile range, IQR).
Students' performance improved more than 200% after training. Learning curves did not differ between groups (p = 0.28). One week after training, scores were 192 s (IQR 65 s) for the control and 190 s (IQR 27 s) for the experimental group (p = 0.63). After 4 months this was 223 s (IQR 88 s) and 220 s (IQR 37 s), respectively (p = 0.60).
Both training methods are very efficient at improving laparoscopic suturing skills and provide excellent skill retention. We therefore conclude that structured training with video demonstrations and peer feedback can replace expert supervision to teach laparoscopic suturing skills to novices. This will facilitate practical organization of skills training.
由于腹腔镜缝合的复杂性，已经开发出许多课程来克服无患者环境下的陡峭学习曲线。与集中培训相比，分布式培训可以更好地获得和保留技能。然而，这需要专家们投入大量的时间来监督这些培训课程。本研究探讨了通过视频演示和同伴反馈替代专家监督进行结构化培训的可能性。
研究人群由两组经验最少的十名高级医学生组成，每组各十名。对照组在连续专家反馈的情况下进行训练，而实验组仅可获得视频演示和来自同伴的外部反馈。当连续两次尝试达到先前确定的专家水平（熟练标准）时，培训即完成。学生在培训后 1 周以及 4 个月后进行缝合技能测试。使用评估缝合性能质量和数量的综合评分。数据显示为中位数（四分位距，IQR）。
学生的表现经过培训后提高了 200%以上。两组的学习曲线没有差异（p = 0.28）。培训后 1 周，对照组的得分为 192 秒（IQR 65 秒），实验组的得分为 190 秒（IQR 27 秒）（p = 0.63）。4 个月后，这分别为 223 秒（IQR 88 秒）和 220 秒（IQR 37 秒）（p = 0.60）。
两种培训方法都非常有效地提高了腹腔镜缝合技能，并提供了出色的技能保留。因此，我们得出结论，通过视频演示和同伴反馈进行结构化培训可以替代专家监督，向新手传授腹腔镜缝合技能。这将有助于更实际地组织技能培训。
