Fried Marvin P, Kaye Rachel J, Gibber Marc J, Jackman Alexis H, Paskhover Boris P, Sadoughi Babak, Schiff Bradley, Fraioli Rebecca E, Jacobs Joseph B
Arch Otolaryngol Head Neck Surg. 2012 Nov 1;138(11):1024-9. doi: 10.1001/2013.jamaoto.377.
OBJECTIVE To investigate whether training otorhinolaryngology residents to criterion performance levels (proficiency) on the Endoscopic Sinus Surgery Simulator produces individuals whose performance in the operating room is at least equal to those who are trained by performing a fixed number of surgical procedures. DESIGN Prospective cohort. SETTING Two academic medical centers in New York City. PARTICIPANTS Otorhinolaryngology junior residents composed of 8 experimental subjects and 6 control subjects and 6 attending surgeons. INTERVENTION Experimental subjects achieved benchmark proficiency criteria on the Endoscopic Sinus Surgery Simulator; control subjects repeated the surgical procedure twice. MAIN OUTCOME MEASURES Residents completed validated objective tests to assess baseline abilities. All subjects were videotaped performing an initial standardized surgical procedure. Residents were videotaped performing a final surgery. Videotapes were assessed for metrics by an expert panel. RESULTS Attendings outperformed the residents in most parameters on the initial procedure. Experimental and attending groups outperformed controls in some parameters on the final procedure. There was no difference between resident groups in initial performance, but the experimental subjects outperformed the control subjects in navigation in the final procedure. Most important, there was no difference in final performance between subgroups of the experimental group on the basis of the number of trials needed to attain proficiency. CONCLUSIONS Simulator training can improve resident technical skills so that each individual attains a proficiency level, despite the existence of an intrinsic range of abilities. This proficiency level translates to at least equal, if not superior, operative performance compared with that of current conventional training with finite repetition of live surgical procedures.
目的 探讨将耳鼻喉科住院医师在内窥镜鼻窦手术模拟器上训练至标准绩效水平（熟练程度）后，其在手术室的表现是否至少等同于通过进行固定数量手术操作进行训练的人员。 设计 前瞻性队列研究。 地点 纽约市的两个学术医疗中心。 参与者 耳鼻喉科初级住院医师，包括8名实验对象、6名对照对象和6名主治外科医生。 干预措施 实验对象在内窥镜鼻窦手术模拟器上达到基准熟练标准；对照对象重复手术操作两次。 主要观察指标 住院医师完成经过验证的客观测试以评估基线能力。所有受试者在进行初始标准化手术操作时均被录像。住院医师在进行最终手术时被录像。录像由专家小组评估各项指标。 结果 在初始手术的大多数参数上，主治医生的表现优于住院医师。在最终手术的某些参数上，实验组和主治医生组的表现优于对照组。住院医师组在初始表现上没有差异，但在最终手术的导航方面，实验对象的表现优于对照对象。最重要的是，根据达到熟练所需的试验次数，实验组亚组之间的最终表现没有差异。 结论 模拟器训练可以提高住院医师的技术技能，使每个人都能达到熟练水平，尽管存在内在的能力范围差异。与目前通过有限次数重复实际手术操作进行的传统训练相比，这种熟练水平转化为至少相当甚至更优的手术表现。
