University of Toronto, Toronto, Canada.
Ann Surg. 2011 May;253(5):886-9. doi: 10.1097/SLA.0b013e31821263ec.
Surgical training in the operating room includes acquiring technical skills and cognitive knowledge. Technical skills training on simulated models has been shown to improve technical performance in the operating room, and may also enhance the acquisition of other skills by freeing cognitive capacity. This has yet to be investigated.
We conducted a single-blinded randomized controlled trial to assess the effect of ex vivo technical skills training on cognitive learning in the operating room. Eighteen novice surgical residents were randomized to 2 groups. All participants were taught the basics of fascial closure and performed 1 closure on a low fidelity synthetic model. Residents in the intervention group practiced on the models until technical proficiency was reached. Residents in the control group had no further contact with the models. All residents then performed a fascial closure on a patient in the operating room while listening to a script that contained relevant clinical information. A validated evaluation tool was used to assess the technical merit of the closure. Finally, all participants completed a multiple-choice test designed to test the information retained from the script.
The technical performance of the ex vivo trained group was significantly higher than that of the untrained group (P = 0.04). The ex vivo trained group also performed significantly better on the cognitive retention test (P = 0.03).
Technical skills training using a low fidelity synthetic simulator resulted in improved technical performance in the operating room, and enhanced the ability of residents to attend to cognitive components of surgical expertise.
手术室中的外科培训包括获取技术技能和认知知识。在模拟模型上进行技术技能培训已被证明可以提高手术室中的技术表现，并且还可以通过释放认知能力来增强其他技能的获取。这尚未得到调查。
我们进行了一项单盲随机对照试验，以评估在手术室中进行体外技术技能训练对认知学习的影响。18 名新手外科住院医师被随机分为 2 组。所有参与者都接受了筋膜闭合基础知识的教学，并在低保真合成模型上进行了 1 次闭合。干预组的居民在模型上练习，直到达到技术熟练程度。对照组的居民则不再与模型接触。然后，所有居民在手术室中为患者进行筋膜闭合，同时听一段包含相关临床信息的脚本。使用经过验证的评估工具来评估闭合的技术优点。最后，所有参与者都完成了多项选择题测试，旨在测试从脚本中保留的信息。
体外训练组的技术表现明显优于未训练组（P=0.04）。体外训练组在认知保留测试中的表现也明显更好（P=0.03）。
使用低保真合成模拟器进行技术技能培训可提高手术室中的技术表现，并增强居民关注手术专业知识认知成分的能力。
