Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, Charlotte, NC 28203, USA.
J Am Coll Surg. 2010 Apr;210(4):436-40. doi: 10.1016/j.jamcollsurg.2009.12.015.
Laparoscopic suturing is an advanced skill that is difficult to acquire. Simulator-based skills curricula have been developed that have been shown to transfer to the operating room. Currently available skills curricula need to be optimized. We hypothesized that mastering basic laparoscopic skills first would shorten the learning curve of a more complex laparoscopic task and reduce resource requirements for the Fundamentals of Laparoscopic Surgery suturing curriculum.
Medical students (n = 20) with no previous simulator experience were enrolled in an IRB-approved protocol, pretested on the Fundamentals of Laparoscopic Surgery suturing model, and randomized into 2 groups. Group I (n = 10) trained (unsupervised) until proficiency levels were achieved on 5 basic tasks; Group II (n = 10) received no basic training. Both groups then trained (supervised) on the Fundamentals of Laparoscopic Surgery suturing model until previously reported proficiency levels were achieved. Two weeks later, they were retested to evaluate their retention scores, training parameters, instruction requirements, and cost between groups using t-test.
Baseline characteristics and performance were similar for both groups, and 9 of 10 subjects in each group achieved the proficiency levels. The initial performance on the simulator was better for Group I after basic skills training, and their suturing learning curve was shorter compared with Group II. In addition, Group I required less active instruction. Overall time required to finish the curriculum was similar for both groups; but the Group I training strategy cost less, with a savings of $148 per trainee.
Teaching novices basic laparoscopic skills before a more complex laparoscopic task produces substantial cost savings. Additional studies are needed to assess the impact of such integrated curricula on ultimate educational benefit.
腹腔镜缝合是一项难以掌握的高级技能。已经开发出基于模拟器的技能课程，这些课程已被证明可以转移到手术室。目前可用的技能课程需要进行优化。我们假设首先掌握基本的腹腔镜技能将缩短更复杂腹腔镜任务的学习曲线，并减少基础腹腔镜手术缝合课程的资源需求。
没有以前模拟器经验的医学生（n = 20）参加了一项经过 IRB 批准的方案，在基础腹腔镜手术缝合模型上进行了预测试，并随机分为 2 组。第 I 组（n = 10）在达到 5 项基本任务的熟练水平之前进行（无监督）培训；第 II 组（n = 10）未进行基本培训。然后，两组都在基础腹腔镜手术缝合模型上接受（监督）培训，直到达到之前报告的熟练水平。两周后，他们进行了重新测试，以使用 t 检验评估组间的保留分数、培训参数、指导要求和成本。
两组的基线特征和表现相似，每组 10 名受试者中有 9 名达到了熟练水平。在进行基本技能培训后，第 I 组在模拟器上的初始表现更好，他们的缝合学习曲线比第 II 组更短。此外，第 I 组需要的主动指导较少。两组完成课程所需的总时间相似；但是第 I 组的培训策略成本较低，每位学员节省 148 美元。
在更复杂的腹腔镜任务之前教授新手基本的腹腔镜技能会产生大量的成本节约。需要进一步的研究来评估这种综合课程对最终教育收益的影响。
