Toronto General Hospital, The Wilson Centre, 200 Elizabeth Street, 1ES 565, Toronto, ON, M5G 2C4, Canada.
Surg Endosc. 2010 Nov;24(11):2830-4. doi: 10.1007/s00464-010-1058-2. Epub 2010 Apr 29.
The purpose of this study was to explore resident perceptions regarding four current models for teaching laparoscopic suturing and to assess the current quality of training in advanced minimally invasive surgical techniques at an academic teaching center.
This study included 14 senior general surgery residents (PGY 3-5) participating in a workshop in advanced laparoscopy. Four training tools were used in the course curriculum: the Fundamentals of Laparoscopic Surgery (FLS) black box suturing model, a synthetic Nissen fundoplication model, a virtual reality (VR) simulator suturing task, and a porcine jejuno-jejunostomy model. After the workshop, residents were asked to complete a questionnaire relating to their experience with laparoscopic surgery, and their opinions regarding the four training models. Model rank was analyzed with one-way ANOVA, and χ(2) analysis with Fisher's exact test was used to analyze model effectiveness.
The majority of residents had strong experience in basic laparoscopic cases such as cholecystectomy and appendectomy; however, few participants had experience in advanced cases. As a group, the residents ranked the porcine model first (average 1.6, median 1), followed by the synthetic Nissen model (average 2.0, median 2), the FLS model (average 2.5, median 3), and the VR trainer (average 3.2, median 4). Finally, each resident was asked to rate the four models individually with respect to their educational value. Scores were on a Likert scale from 1 to 5. Nine of 11 (81.8%) residents rated the animal model as "extremely helpful" while only 3 of 14 (21.4%) participants rated the VR model as "extremely helpful" (p = 0.048).
This study demonstrates that operative experience in advanced laparoscopy for senior residents is suboptimal. Residents learning this skill in a simulated environment prefer animal or video-trainers as teaching models rather than virtual reality. This has implications when designing a curriculum for advanced endoscopy.
本研究旨在探讨住院医师对当前四种腹腔镜缝合教学模式的看法，并评估学术教学中心高级微创外科技术的当前培训质量。
本研究纳入了 14 名参加高级腹腔镜课程的普外科住院医师（PGY3-5）。课程课程中使用了四种培训工具：腹腔镜手术基础（FLS）黑盒缝合模型、合成 Nissen 胃底折叠模型、虚拟现实（VR）模拟器缝合任务和猪空肠-空肠吻合模型。在研讨会结束后，住院医师完成了一份与腹腔镜手术经验及其对四种培训模型的看法相关的问卷。采用单因素方差分析对模型等级进行分析，采用卡方检验（Fisher 确切检验）分析模型的有效性。
大多数住院医师在胆囊切除术和阑尾切除术等基本腹腔镜手术方面有丰富的经验；然而，很少有参与者有高级病例的经验。作为一个整体，住院医师将猪模型排在第一位（平均 1.6，中位数 1），其次是合成 Nissen 模型（平均 2.0，中位数 2）、FLS 模型（平均 2.5，中位数 3）和 VR 训练器（平均 3.2，中位数 4）。最后，每位住院医师根据教育价值对这四种模型分别进行评分。评分采用 1 到 5 的李克特量表。11 名住院医师中有 9 名（81.8%）将动物模型评为“非常有帮助”，而 14 名住院医师中有 3 名（21.4%）将 VR 模型评为“非常有帮助”（p = 0.048）。
本研究表明，高级腹腔镜手术的住院医师手术经验不足。在模拟环境中学习这项技能的住院医师更喜欢动物或视频训练器作为教学模型，而不是虚拟现实。这对高级内镜课程的设计具有启示意义。
