Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Medical Center, 1000 Blythe Boulevard, MEB 601, Charlotte, NC 28203, USA.
Surgery. 2010 May;147(5):640-5. doi: 10.1016/j.surg.2010.01.007.
Proficiency-based simulator training in laparoscopic suturing leads to improved operative performance, but the skill transfer is incomplete. The objective of this study was to examine the stress level of trainees during the transition from the simulator to the operating room (OR) and its impact on performance.
Novices (n = 20) were randomized into training and control groups. After the training group achieved proficiency in laparoscopic suturing, both groups were tested on a live porcine, laparoscopic Nissen fundoplication model. Participant performance was assessed using an objective score. Stress level was evaluated by recording beat-to-beat heart rate (BBHR) and short-term heart rate variability (STHRV) at baseline, after achieving proficiency (only the training group) and in the OR. Repeated measurement analysis of variance (ANOVA) and t test were used for analysis.
Baseline simulator performance and data for heart rate variability were similar for both groups. After achieving simulator proficiency, the trained group demonstrated the anticipated decrease in performance (mean average + or - SEM) in the OR (524 + or - 17 vs 290 + or - 95; P < .001), and an increase in BBHR (98 + or - 14 vs115 + or - 18; P < .001) but not STHRV (4.1 + or - 0.8 vs 3.7 + or - 0.9; P = .5). A similar but lesser increase of the BBHR was observed in the control group compared to the study group.
BBHR was a more sensitive measure of stress level compared with STHRV. The increased BBHR observed in the OR that reflects stress and performance anxiety may explain the incomplete transfer of simulator-acquired skill in novice learners.
基于熟练度的腹腔镜缝合模拟器训练可提高手术操作性能，但技能转移并不完全。本研究旨在考察从模拟器过渡到手术室（OR）时学员的压力水平及其对表现的影响。
将新手学员（n=20）随机分为培训组和对照组。在培训组达到腹腔镜缝合熟练度后，两组均在活体猪腹腔镜 Nissen 胃底折叠模型上进行测试。使用客观评分评估参与者的表现。通过记录基线、达到熟练度后（仅培训组）和 OR 中的逐拍心率（BBHR）和短期心率变异性（STHRV）来评估压力水平。使用重复测量方差分析（ANOVA）和 t 检验进行分析。
两组基线模拟器性能和心率变异性数据相似。达到模拟器熟练度后，受训组在 OR 中表现出预期的下降（平均+或-SEM）（524+或-17 对 290+或-95；P<.001），BBHR 增加（98+或-14 对 115+或-18；P<.001），但 STHRV 无变化（4.1+或-0.8 对 3.7+或-0.9；P=.5）。对照组与研究组相比，BBHR 也有类似但较小的增加。
与 STHRV 相比，BBHR 是衡量压力水平的更敏感指标。在 OR 中观察到的增加的 BBHR 反映了压力和表现焦虑，这可能解释了新手学员从模拟器获得的技能转移不完全的原因。
