Department of Vascular Surgery, University of California-Los Angeles, Los Angelese, CA, USA.
J Vasc Surg. 2011 Jan;53(1):229-234, 235.e1-2; discussion 234-5. doi: 10.1016/j.jvs.2010.07.064. Epub 2010 Nov 5.
Standardizing surgical skills teaching has been proposed as a method to rapidly attain technical competence. This study compared acquisition of vascular skills by standardized vs traditional teaching methods.
The study randomized 18 first-year surgical residents to a standardized or traditional group. Participants were taught technical aspects of vascular anastomosis using femoral anastomosis simulation (Limbs & Things, Savannah, Ga), supplemented with factual information. One expert instructor taught a standardized anastomosis technique using the same method each time to one group over four sessions, while, similar to current vascular training, four different expert instructors each taught one session to the other (traditional) group. Knowledge and technical skill were assessed at study completion by an independent vascular expert using Objective Structured Assessment of Technical Skill (OSATS) performance metrics. Participants also provided a written evaluation of the study experience.
The standardized group had significantly higher mean overall technical (95.7% vs 75.8%; P = .038) and global skill scores (83.4% vs 67%; P = .006). Tissue handling, efficiency of motion, overall technical skill, and flow of operation were rated significantly higher in the standardized group (mean range, 88%-96% vs 67.6%-77.6%; P < .05). The standardized group trended to better cognitive knowledge (mean, 68.8% vs 60.7%; P = .182), creation of a secure knot at the toe of the anastomosis, fashioning an appropriate arteriotomy, better double-ended suture placement at the heel of the anastomosis (100% vs 62.7%; P = .07), and accurate suture placement (70% vs 25%; P = .153). Seventy-two percent of participant evaluations suggested a preference for a standardized approach.
This study demonstrates the feasibility of open vascular simulation to assess the effect of differing teaching methods on performance outcome. Findings from this report suggest that for simulation training, standardized may be more effective than traditional methods of teaching. Transferability of simulator-acquired skills to the clinical setting will be required before open simulation can be unequivocally recommended as a major component of resident technical skill training.
标准化手术技能教学已被提议作为一种快速获得技术能力的方法。本研究比较了标准化与传统教学方法对血管技能的习得效果。
本研究将 18 名第一年的外科住院医师随机分为标准化组或传统组。参与者使用股动脉吻合模拟（萨凡纳，格鲁吉亚的 Limbs & Things）接受血管吻合技术的各个方面的教学，同时辅以事实信息。一名专家讲师每次使用相同的方法向一个组教授标准化吻合技术，共进行四节课，而类似当前的血管培训，四名不同的专家讲师各自向另一个（传统）组教授一节课。研究结束时，由一名独立的血管专家使用客观结构化评估技术技能（OSATS）绩效指标评估知识和技术技能。参与者还对研究经验进行了书面评价。
标准化组的总体技术（95.7%比 75.8%；P=0.038）和总体技能评分（83.4%比 67%；P=0.006）显著更高。组织处理、运动效率、总体技术技能和手术流程在标准化组中得到了更高的评分（评分范围，88%-96%比 67.6%-77.6%；P<0.05）。标准化组在认知知识方面也有更好的趋势（平均 68.8%比 60.7%；P=0.182），在吻合口的脚趾处打一个安全结、制作适当的动脉切口、在吻合口的脚跟处更好地放置双端缝线（100%比 62.7%；P=0.07）和准确放置缝线（70%比 25%；P=0.153）的能力更好。72%的参与者评估表明他们更喜欢标准化方法。
本研究证明了开放血管模拟评估不同教学方法对绩效结果的影响的可行性。本报告的结果表明，对于模拟培训，标准化方法可能比传统教学方法更有效。在明确推荐开放模拟作为住院医师技术技能培训的主要组成部分之前，需要将模拟器获得的技能转移到临床环境中。
