Carolinas Simulation Center, Carolinas Medical Center, Charlotte, NC, USA.
Ann Surg. 2012 Jan;255(1):30-7. doi: 10.1097/SLA.0b013e318220ef31.
We hypothesized that novices will perform better in the operating room after simulator training to automaticity compared with traditional proficiency based training (current standard training paradigm).
Simulator-acquired skill translates to the operating room, but the skill transfer is incomplete. Secondary task metrics reflect the ability of trainees to multitask (automaticity) and may improve performance assessment on simulators and skill transfer by indicating when learning is complete.
Novices (N = 30) were enrolled in an IRB-approved, blinded, randomized, controlled trial. Participants were randomized into an intervention (n = 20) and a control (n = 10) group. The intervention group practiced on the FLS suturing task until they achieved expert levels of time and errors (proficiency), were tested on a live porcine fundoplication model, continued simulator training until they achieved expert levels on a visual spatial secondary task (automaticity) and were retested on the operating room (OR) model. The control group participated only during testing sessions. Performance scores were compared within and between groups during testing sessions.
: Intervention group participants achieved proficiency after 54 ± 14 and automaticity after additional 109 ± 57 repetitions. Participants achieved better scores in the OR after automaticity training [345 (range, 0-537)] compared with after proficiency-based training [220 (range, 0-452; P < 0.001].
Simulator training to automaticity takes more time but is superior to proficiency-based training, as it leads to improved skill acquisition and transfer. Secondary task metrics that reflect trainee automaticity should be implemented during simulator training to improve learning and skill transfer.
我们假设与传统基于熟练度的培训（当前标准培训模式）相比，新手在经过模拟器培训达到自动化后，在手术室中的表现会更好。
从模拟器获得的技能可以转化到手术室中，但技能的转移并不完全。次要任务指标反映了受训者进行多任务处理的能力（自动化），并且通过指示何时完成学习，可能会提高模拟器上的绩效评估和技能转移。
将 30 名新手（N=30）纳入一项经机构审查委员会批准的、盲法、随机、对照试验中。参与者被随机分为干预组（n=20）和对照组（n=10）。干预组在 FLS 缝合任务上进行练习，直到达到时间和错误的专家水平（熟练度），在活体猪胃底折叠模型上进行测试，继续在模拟器上进行训练，直到在视觉空间次要任务上达到专家水平（自动化），然后在手术室（OR）模型上进行再次测试。对照组仅在测试期间参与。在测试期间，对组内和组间的绩效评分进行比较。
干预组参与者在完成 54±14 次重复后达到熟练程度，在额外完成 109±57 次重复后达到自动化程度。与基于熟练度的培训后[220（范围，0-452）相比，参与者在自动性培训后在 OR 中取得了更好的成绩[345（范围，0-537）；P<0.001]。
与基于熟练度的培训相比，模拟器培训达到自动化程度需要更多时间，但效果更好，因为它可以提高技能的获取和转移。在模拟器培训期间，应实施反映受训者自动化程度的次要任务指标，以提高学习效果和技能转移。
