Division of Thoracic Surgery, Georgetown University Medical Center, Washington, DC 20007, USA.
J Surg Res. 2012 May 15;174(2):250-6. doi: 10.1016/j.jss.2011.01.055. Epub 2011 Mar 1.
Inclusion of specialized simulation into surgery training may enhance the educational experience of residents. We set out to develop a simulated chest wall tumor model to teach the specifics skills needed for chest wall tumor resection with prosthetic reconstruction.
The model was constructed from porcine rib blocs and additional materials (Fig. 1A and B). Thirteen general surgery residents were asked to perform en bloc tumor resection with "mesh sandwich" reconstruction of the chest wall defect (Fig. 2A and B). Evaluation consisted of knowledge-based examination, operative time, and skill assessment with an objective checklist and subjective global rating scale. A thoracic surgeon proctored and evaluated the practice sessions.
Scores on the knowledge-based examination suggested no association with resident training year. More time was needed by junior level residents to complete the simulated operative task, even though the average time improved with repetitive practice. Average task-specific scores were comparable amongst the resident groups. The mid-level residents demonstrated the greatest improvement in skill proficiency; however, scores were consistently highest amongst the PGY-5s
Our data suggest simulation is an effective teaching tool and training module for skill development needed for rarely performed procedures. The incorporation of this and similar simulation trainers is likely to improve surgical education and patient safety.
将专业模拟纳入外科培训可能会增强住院医师的教育体验。我们开发了一种模拟胸壁肿瘤模型，以教授胸壁肿瘤切除和假体重建所需的具体技能。
该模型由猪肋骨块和其他材料构建（图 1A 和 B）。13 名普通外科住院医师被要求进行整块肿瘤切除术，并采用“网片三明治”法重建胸壁缺损（图 2A 和 B）。评估包括基于知识的考试、手术时间以及使用客观检查表和主观整体评分量表进行的技能评估。一名胸外科医生监督和评估实践课程。
基于知识的考试成绩与住院医师培训年限无关。初级住院医师完成模拟手术任务所需的时间更长，尽管随着重复练习，平均时间有所提高。住院医师组的平均特定任务评分相当。中级住院医师的技能熟练程度提高最大；然而，PGY-5 组的得分始终最高。
我们的数据表明，模拟是一种有效的教学工具，也是针对罕见手术所需技能发展的培训模块。这种模拟训练器的引入可能会提高手术教育和患者安全水平。
