Division of Vascular Surgery, Department of Surgery, University of Vermont, Burlington, Vermont, USA.
Simul Healthc. 2012 Dec;7(6):334-8. doi: 10.1097/SIH.0b013e318264655e.
Reduced work hours and concerns over patient safety have encouraged surgical educators to find methods to advance resident skills more efficiently. Simulation provides the opportunity to improve technical surgical skills outside the operating room. We hypothesized that practice on surgical task simulators would improve residents' technical performance of vascular anastomotic technique.
Senior general surgery residents at an academic medical center completed pretests and posttests on 3 vascular surgery simulators: femoral-popliteal bypass, carotid endarterectomy, and abdominal aortic aneurysm repair. The initial training sessions began with a 15-minute instructional video on how to perform the procedures, followed by supervised sessions in anastomotic technique with attending vascular surgeons. Initial individual sessions were videotaped as a pretest, and the final attempt was videotaped as the posttest. Each test was evaluated by a single experienced attending vascular surgeon blinded to the examinees. Anastomoses were graded using a performance rating and a modified objective structured assessment of technical skill rating. Results were analyzed using mixed model P values.
The residents showed statistically significant improvement between the pretest and the posttest in both their performance rating (1.9 vs. 2.4, P = 0.02) and the objective structured assessment of technical skill (2.6 vs. 3.1, P = 0.01), as well as in most subsets of each assessment scale.
We conclude that practice using simulated anastomotic models leads to measurable improvement in vascular anastomotic technique in senior general surgery residents.
减少工作时间和对患者安全的担忧促使外科教育工作者寻找更有效地提高住院医师技能的方法。模拟提供了在手术室之外提高技术外科技能的机会。我们假设在手术任务模拟器上进行练习将提高住院医师的血管吻合技术的技术表现。
在一家学术医疗中心，高级普通外科住院医师在 3 种血管外科模拟器上完成了预测试和后测试：股-腘旁路、颈动脉内膜切除术和腹主动脉瘤修复。初始培训课程开始时，播放 15 分钟的关于如何进行手术的教学视频，然后由主治血管外科医生进行吻合技术的监督培训。初始的个人课程被拍摄为预测试，最后一次尝试被拍摄为后测试。每位测试者都由一位经验丰富的主治血管外科医生进行评估，该医生对考生不了解。吻合术使用绩效评分和改良的客观结构化技术技能评估评分进行评估。结果使用混合模型 P 值进行分析。
住院医师在绩效评分（1.9 对 2.4，P = 0.02）和客观结构化技术技能评估评分（2.6 对 3.1，P = 0.01）方面，以及在每个评估量表的大多数子集中，都显示出了预测试和后测试之间具有统计学意义的显著改善。
我们得出结论，使用模拟吻合模型进行练习可导致高级普通外科住院医师的血管吻合技术有可衡量的提高。
