Division of Rheumatology, The Hospital for Special Surgery-Weill Cornell Medical College, New York, NY, USA.
J Clin Rheumatol. 2012 Jun;18(4):175-9. doi: 10.1097/RHU.0b013e318258259e.
Each year, rheumatology programs across the country teach incoming trainees the skill of arthrocentesis, but the relative effectiveness of various teaching techniques has not been assessed in a systematic way.
We compared approaches to teaching arthrocentesis using cadavers versus anatomic models.
In a pilot study, new rheumatology fellows (n = 7) from 2 academic institutions were surveyed at 3 points during arthrocentesis training: (1) before assuming patient care; (2) after lecture with handouts, followed by practice either on cadavers (group A) or on synthetic joint models (group B); and (3) 6 weeks into fellowship. Fellows rated their comfort levels for arthrocentesis of specific joints using 9-point Likert scales. Fellows also retrospectively rated the utility of individual teaching modalities in helping them to learn. As a follow-up study, internal medicine residents taking part in a month-long rheumatology rotation were similarly surveyed on their comfort level performing knee and shoulder arthrocentesis before a cadaver teaching laboratory and at the end of their month rotation.
The initial mean comfort level performing arthrocentesis for all fellows was low (2.01). After the cadaver teaching session, group A fellows experienced an overall comfort level increase of 1.95, with the largest single increase reported for shoulder arthrocentesis (3.86). After the anatomic model teaching session, group B fellows reported a mean comfort increase of 1.29, with the largest increase reported for knee arthrocentesis (3.13). The subsequent study with residents confirmed significant increases in comfort after the cadaver laboratory. When surveyed, the learning experience fellows considered most effective was the opportunity to perform procedures under supervision and guidance, followed by training on cadavers.
Although all teaching interventions for trainees learning arthrocentesis were helpful for increasing trainee's comfort with arthrocentesis, the use of cadavers seemed to be superior to synthetic anatomic models or lectures alone. The specific impact of these teaching interventions on actual competence, defined as a performance outcome, deserves additional study.
每年，全国各地的风湿病项目都教授新学员关节穿刺术的技能，但尚未以系统的方式评估各种教学技术的相对有效性。
我们比较了使用尸体和解剖模型教授关节穿刺术的方法。
在一项试点研究中，来自 2 所学术机构的新风湿病研究员（n = 7）在关节穿刺术培训的 3 个时间点接受了调查：（1）开始患者护理之前；（2）讲座后附有讲义，然后在尸体（A 组）或合成关节模型（B 组）上进行练习；（3）进入 fellowship 6 周后。研究员使用 9 分李克特量表对特定关节关节穿刺术的舒适度水平进行评分。研究员还回顾性评估了各个教学模式在帮助他们学习方面的实用性。作为后续研究，接受为期 1 个月的风湿病轮转的内科住院医师在接受尸体教学实验室和轮训结束时，同样对膝关节和肩关节关节穿刺术的舒适度进行了调查。
所有研究员最初进行关节穿刺术的舒适度平均水平较低（2.01）。在尸体教学课程之后，A 组研究员的整体舒适度水平提高了 1.95，肩关节关节穿刺术的报告最大单项增加（3.86）。在解剖模型教学课程之后，B 组研究员报告的舒适度平均增加了 1.29，膝关节关节穿刺术的报告最大增加（3.13）。随后对住院医师的研究证实，在尸体实验室之后，舒适度有了显著提高。当被调查时，研究员认为最有效的学习经验是在监督和指导下进行操作的机会，其次是在尸体上进行培训。
尽管所有针对关节穿刺术学习者的教学干预措施都有助于提高学员对关节穿刺术的舒适度，但与单独使用尸体相比，使用尸体似乎优于合成解剖模型或讲座。这些教学干预措施对实际能力（定义为绩效结果）的具体影响值得进一步研究。
