Balasundaram Indran, Aggarwal Rajesh, Darzi Lord Ara
Department of Biosurgery & Surgical Technology, Imperial College, London, United Kingdom.
Br J Oral Maxillofac Surg. 2010 Dec;48(8):598-606. doi: 10.1016/j.bjoms.2009.11.010. Epub 2010 Jan 6.
Recent changes in healthcare necessitate revision of the current apprenticeship model of surgical training. Current methods of assessment such as examinations and logbooks are not criteria-based, so are subjective and lack validity and reliability. The objective feedback of technical skills is crucial to the structured learning of surgical skills. We review current publications about training and methods of assessment in microsurgery. Searches on PubMed using keywords (microsurgery, training, assessment, simulation, and skill) were used to retrieve relevant articles, and further cross-referencing was done to obtain more information. New methods of assessment that are objective include checklists, global rating scales (GRS), and dexterity analysis, which give feedback of technical skills during training. Vital (living), non-vital, prosthetic, and virtual reality simulation models can be used to train surgeons to a proficient level outside the operating theatre before they operate on real patients. After reviewing the current evidence we propose a curriculum for microsurgical training that starts outside the operating theatre. The surgical community should follow the example of other high-risk industries such as aviation, where continuous assessment on simulators is a part of training, but further research is necessary before such methods can be used for summative assessment and revalidation.
近期医疗保健领域的变革使得现行的外科培训学徒模式需要修订。当前诸如考试和日志等评估方法并非基于标准，因此主观且缺乏效度和信度。技术技能的客观反馈对于外科技能的结构化学习至关重要。我们回顾了当前有关显微外科培训及评估方法的出版物。使用关键词（显微外科、培训、评估、模拟和技能）在PubMed上进行检索以获取相关文章，并进一步交叉引用以获取更多信息。客观的新评估方法包括检查表、整体评分量表（GRS）和灵巧性分析，这些方法在培训期间提供技术技能反馈。活体、非活体、假体和虚拟现实模拟模型可用于在外科医生对真实患者进行手术之前，在手术室外将他们培训到熟练水平。在回顾当前证据后，我们提出了一个始于手术室外的显微外科培训课程。外科界应效仿其他高风险行业，如航空业，在航空业中，在模拟器上进行持续评估是培训的一部分，但在这些方法可用于总结性评估和再认证之前，还需要进一步研究。
