开发和验证一门综合性课程，以教授先进的微创手术：一项随机对照试验。

Development and validation of a comprehensive curriculum to teach an advanced minimally invasive procedure: a randomized controlled trial.

机构信息

Department of Surgery, University of Toronto, Toronto, Ontario, Canada.

出版信息

Ann Surg. 2012 Jul;256(1):25-32. doi: 10.1097/SLA.0b013e318258f5aa.

DOI:10.1097/SLA.0b013e318258f5aa

PMID:22664557

Abstract

OBJECTIVE

To develop and validate a comprehensive ex vivo training curriculum for laparoscopic colorectal surgery.

BACKGROUND

Simulators have been shown to be viable systems for teaching technical skills outside the operating room; however, integration of simulation training into comprehensive curricula remains a major challenge in modern surgical education. Currently, no curricula have been described or validated for advanced laparoscopic procedures.

METHODS

This prospective, single-blinded randomized controlled trial allocated 25 surgical residents to receive either conventional residency training or a comprehensive training curriculum for laparoscopic colorectal surgery. The curriculum consisted of proficiency-based psychomotor training on a virtual reality simulator, cognitive training, and participation in a cadaver lab. The primary outcome measure in this study was surgical performance in the operating room. All participants performed a laparoscopic right colectomy, which was video recorded and assessed using 2 previously validated assessment tools. Secondary outcome measures were knowledge relating to the execution of the procedure, assessed with a multiple-choice test, and technical performance on the simulator.

RESULTS

Curricular-trained residents demonstrated superior performance in the operating room compared with conventionally trained residents (global score 16.0 [14.5-18.0] versus 8.0 [6.0-14.5], P = 0.030; number of operative steps performed 16.0 [12.5-17.5] versus 8.0 [6.0-14.5], P = 0.021; procedure-specific score 71.1 [54.4-81.6] versus 51.1 [36.7-74.4], P = 0.122). Curricular-trained residents scored higher on the multiple-choice test (10 [9-11] versus 7.5 [5.3-7.5], P = 0.047), and outperformed conventionally trained residents in 7 of 8 tasks on the simulator.

CONCLUSIONS

Participation in a comprehensive ex vivo training curriculum for laparoscopic colorectal surgery results in improved technical knowledge and improved performance in the operating room compared with conventional residency training. Reg. ID#NCT 01371136.

摘要

目的

开发并验证腹腔镜结直肠手术的综合体外培训课程。

背景

模拟器已被证明是在手术室之外教授技术技能的可行系统；然而，将模拟培训纳入综合课程仍然是现代外科教育的主要挑战。目前，还没有描述或验证过用于高级腹腔镜手术的课程。

方法

这项前瞻性、单盲随机对照试验将 25 名外科住院医师分为接受常规住院医师培训或腹腔镜结直肠手术综合培训课程的两组。该课程包括基于熟练度的虚拟现实模拟器心理运动训练、认知训练和参加尸体实验室。本研究的主要观察指标是手术室的手术表现。所有参与者均进行腹腔镜右结肠切除术，手术过程进行视频记录，并使用 2 种先前验证的评估工具进行评估。次要观察指标是与手术执行相关的知识，使用多项选择题进行评估，以及模拟器上的技术表现。

结果

与接受常规培训的住院医师相比，接受课程培训的住院医师在手术室中的表现更优（总体评分为 16.0[14.5-18.0] 与 8.0[6.0-14.5]，P = 0.030；完成的手术步骤数量为 16.0[12.5-17.5] 与 8.0[6.0-14.5]，P = 0.021；特定于手术的评分 71.1[54.4-81.6] 与 51.1[36.7-74.4]，P = 0.122）。接受课程培训的住院医师在多项选择题中的得分更高（10[9-11] 与 7.5[5.3-7.5]，P = 0.047），并且在模拟器的 8 项任务中的 7 项中表现优于接受常规培训的住院医师。