Charles University in Prague, Department of Internal Medicine, First Faculty of Medicine and Central Military Hospital, Prague, Czech Republic.
Gastrointest Endosc. 2011 Aug;74(2):367-73. doi: 10.1016/j.gie.2011.04.042.
Animal models are used for training of different endoscopic procedures. Whether this really improves endoscopic skills remains controversial.
To assess the effectiveness of training by using an ex vivo animal gastric model on the performance of two therapeutic procedures-hemostasis and treatment of perforation.
A randomized, single-blind study.
An experimental endoscopy center in a university hospital.
Thirty-one gastroenterology fellows with comparable endoscopic experience.
Participants were randomized into two groups: with (T, n = 16) and without (S, n = 15) training. All fellows continued with standard endoscopic practice. Baseline skills were assessed at enrollment. All physicians in group T underwent 2 full days of a hands-on course over a 3-month period, in addition to their standard endoscopic practice. Both groups then underwent a blinded, final evaluation. Endoscopic skills were scored from 1 (best) to 5 (poorest) by two expert, blinded tutors. Outcomes of clinical hemostatic procedures also were analyzed.
Successful hemostasis and successful perforation closure.
Thirty physicians completed the study. Hemostasis results (n = 15): The number of physicians who carried out a successful hemostasis procedure increased significantly in the group with training (27% vs 73%; P = .009) but did not change in the group without training (20% vs 20%). The mean scores of injection and clipping technique improved significantly only after training. The number of clips used decreased significantly only in the group with training; the time of clipping did not change significantly in either group. Perforation results (n = 15): The number of physicians with a successful and complete perforation closure increased nearly significantly in the group with training (40% vs 73%, P = .06) as opposed to the group without training (27% vs 47%; P = .27). The procedure time decreased significantly in the group with training only. In clinical practice, fellows in group T had a significantly higher success rate with respect to hemostatic procedures (83.2%, range 67-100 vs 63.6%, range 25-100; P = .0447). The majority of participants (93%) agreed that such courses should be compulsory in gastroenterological credentials.
A retrospective analysis of clinical outcomes. Clinical outcome data were based on self-reporting of the participants.
Hands-on training by using an animal ex vivo model improves endoscopic skills in both hemostasis and perforation closure. In clinical practice, the training improves the outcome of hemostatic procedures.
动物模型被用于培训各种内镜手术。然而，这种方法是否真的能提高内镜技能仍存在争议。
评估使用离体动物胃模型进行两种治疗性操作（止血和穿孔治疗）的培训效果。
随机、单盲研究。
大学医院的实验内镜中心。
31 名具有相似内镜经验的消化科住院医师。
参与者被随机分为两组：有培训组（T 组，n = 16）和无培训组（S 组，n = 15）。所有住院医师均继续进行标准内镜实践。在入组时评估基线技能。除了标准内镜实践外，T 组的所有医师都参加了为期 3 个月的 2 天实地课程。然后，两组都进行了盲法最终评估。由两位专家盲法导师对内镜技能进行 1（最佳）至 5（最差）分的评分。还分析了临床止血操作的结果。
成功止血和成功穿孔闭合。
30 名医师完成了研究。止血结果（n = 15）：接受培训的组中，能够成功进行止血操作的医师人数显著增加（27%比 73%；P =.009），而未接受培训的组则没有变化（20%比 20%）。仅在培训后，注射和夹闭技术的平均评分显著提高。仅在接受培训的组中，使用的夹数量显著减少；两组的夹闭时间均无显著变化。穿孔结果（n = 15）：接受培训的组中，能够成功完全闭合穿孔的医师人数几乎显著增加（40%比 73%，P =.06），而未接受培训的组则没有变化（27%比 47%；P =.27）。仅在培训组中，手术时间显著缩短。在临床实践中，T 组的住院医师在止血操作方面的成功率显著更高（83.2%，范围 67-100%比 63.6%，范围 25-100%；P =.0447）。大多数参与者（93%）认为此类课程在胃肠病学资格认证中应是强制性的。
对临床结果的回顾性分析。临床结果数据基于参与者的自我报告。
使用离体动物模型进行的实践培训可提高止血和穿孔闭合的内镜技能。在临床实践中，培训可提高止血操作的结果。
