Department of Orthopaedic Surgery, University of California San Francisco, 500 Parnassus Avenue, Box 0728-MU 320W, San Francisco, CA 94143, USA.
J Bone Joint Surg Am. 2012 Dec 5;94(23):e1771-7. doi: 10.2106/JBJS.K.00840.
Much of the difficulty in understanding acetabular fracture patterns is due to the complex three-dimensional relationship of the acetabulum to the greater pelvis. We hypothesized that combining three-dimensional "hands-on" anatomic models with two-dimensional informational teaching sheets would improve the ability of orthopaedic residents to accurately classify acetabular fracture patterns and aid in preoperative surgical approach selection.
Thirty-five orthopaedic residents from two programs accredited by the Accreditation Council for Graduate Medical Education participated in this prospective study. Twenty-question quizzes based on radiographs and computed tomography images of acetabular fractures tested the ability of the residents to accurately classify these fractures. One-half of the residents had access to informational teaching sheets only, and the other group had access to three-dimensional pelvic models of the fractures in addition to the informational sheets.
There was a positive correlation between the postgraduate year in training and the mean pre-intervention quiz score (r2 = 0.89). The mean improvement in the quiz score was 15% ± 15% for first and second-year residents compared with 3% ± 12% for fourth and fifth-year residents (p = 0.04). The resident group that used the three-dimensional "hands-on" models showed greater post-intervention improvement in the quiz score.
In this preliminary study, active learning that incorporated three-dimensional "hands-on" pelvic models improved the ability of orthopaedic residents to accurately classify acetabular fracture patterns compared with use of informational teaching sheets alone.
理解髋臼骨折模式的困难很大程度上是由于髋臼与骨盆之间复杂的三维关系所致。我们假设，将三维“动手”解剖模型与二维信息教学表相结合，将提高骨科住院医师准确分类髋臼骨折模式的能力，并有助于术前选择手术入路。
本前瞻性研究纳入了来自两个经研究生医学教育认证委员会认证的项目的 35 名骨科住院医师。20 道基于髋臼骨折的 X 线片和 CT 图像的问答题测试了住院医师准确分类这些骨折的能力。一半的住院医师仅可获得信息教学表，而另一组除了信息表之外，还可获得髋臼骨折的三维骨盆模型。
培训后的研究生年数与干预前测试成绩的平均分呈正相关（r2=0.89）。与第四年和第五年住院医师的 3%±12%相比，第一年和第二年住院医师的测试成绩平均提高了 15%±15%（p=0.04）。使用三维“动手”模型的住院医师组在测试成绩上的干预后改善更为显著。
在这项初步研究中，与仅使用信息教学表相比，融入三维“动手”骨盆模型的主动学习提高了骨科住院医师准确分类髋臼骨折模式的能力。
