Southwestern Center for Minimally Invasive Surgery, UT Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9156, USA.
Surg Endosc. 2010 Oct;24(10):2453-7. doi: 10.1007/s00464-010-0985-2. Epub 2010 Mar 27.
The authors have previously documented a 100% certification pass rate immediately after a proficiency-based skills training curriculum for the Fundamentals of Laparoscopic Surgery (FLS) program. This study aimed to determine the durability of skills acquired after initial training.
For this study, 21 novice medical students were enrolled in institutional review board (IRB)-approved protocols at two institutions. As previously reported, all the participants successfully completed a structured proficiency-based training curriculum by practicing the five FLS tasks in a distributed fashion over a 2-month period. Pre- and posttesting was conducted, and standard testing metrics were used. The participants were recruited for repeat testing 6 months (retention 1) and 1 year (retention 2) after initial curriculum completion. Of the original 21 students, 15 (10 at University of Texas Southwestern and 5 at Uniformed Services University) were available and agreed to participate. The participants had no additional skills lab training and minimal clinical laparoscopic exposure.
None of the 15 participants demonstrated proficiency at the initial pretest (mean score, 146 ± 65), and performance showed significant improvement (p < 0.001) at the posttest (469 ± 20). The participants retained a very high level of performance at retention 1 (437 ± 39; 93% retention of the posttest score) and retention 2 (444 ± 55; 95% retention of the posttest score). Their performance at both retention testing-intervals was sufficient for passing the certification exam (270 cutoff score for passing) with a comfortable margin. There were no significant differences in performance between the two institutions at any time points.
The proficiency-based FLS skills curriculum reliably results in a high level of skill retention, even in the absence of ongoing simulator-based training or clinical experience. This curriculum is suitable for widespread implementation.
作者先前记录了一项基于熟练度的腹腔镜手术基础（FLS）课程培训后，学员的认证通过率达到了 100%。本研究旨在确定初始培训后获得的技能的持久性。
在这项研究中，21 名新手医学生在两个机构的机构审查委员会（IRB）批准的方案中注册。如前所述，所有参与者都通过在 2 个月的时间内以分布式方式练习 FLS 的五个任务，成功完成了结构化的基于熟练度的培训课程。进行了预测试和后测试，并使用了标准测试指标。在初始课程完成后 6 个月（保留 1）和 1 年（保留 2）时，招募参与者进行重复测试。在最初的 21 名学生中，有 15 名（10 名在德克萨斯大学西南分校，5 名在统一服务大学）有意愿并同意参加。这些参与者没有接受额外的技能实验室培训，也没有接受过最低限度的临床腹腔镜手术经验。
在初始预测试中，没有一名参与者表现出熟练程度（平均得分为 146±65），而在后测试中（469±20）表现出显著提高（p<0.001）。在保留 1 时（437±39；保留后测得分的 93%）和保留 2 时（444±55；保留后测得分的 95%），参与者保持了非常高的水平。他们在两次保留测试中的表现都足以通过认证考试（通过的 270 分截止点），并有很大的余地。在任何时间点，两个机构之间的表现都没有显著差异。
基于熟练度的 FLS 技能课程确实能可靠地获得高水平的技能保留，即使没有持续的模拟器培训或临床经验。这种课程适合广泛实施。
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