Vanderbilt University Medical Center, Department of Thoracic Surgery, Nashville, Tenn, USA.
J Thorac Cardiovasc Surg. 2013 Jun;145(6):1453-8; discussion 1458-9. doi: 10.1016/j.jtcvs.2013.02.048. Epub 2013 Mar 15.
The study objective was to assess the impact of dedicated instruction and deliberate practice on fourth-year medical students' proficiency in performing a coronary anastomosis using a porcine heart model, compared with nonsimulator-trained senior general surgery residents.
Ten fourth-year medical students were trained to perform a coronary anastomosis using the porcine simulator. Students trained for 4 months using deliberate practice methodology and one-on-one instruction. At the end of the training, each student was filmed performing a complete anastomosis. Eleven senior general surgery residents were filmed performing an anastomosis after a single tutorial. All films were graded by 3 independent cardiac surgeons in a blinded fashion. The primary outcome was the median final score (range, 1-10) of a modified Objective Structured Assessment of Technical Skill scale. The secondary outcome was time to completion in seconds. Statistical analysis used both parametric (Student t test) and nonparametric (Wilcoxon rank-sum) methods.
The median combined final score for medical students was 3 (interquartile range, 2.3-4.8), compared with 4 (interquartile range, 3.3-5.3) for residents (P = .102). The overall median individual final scores were 3 (interquartile range, 2-6) for grader 1, 3 (interquartile range, 2-5) for grader 2, and 4 (interquartile range, 3-5) for grader 3. For each individual grader, there was no difference in median final scores between medical students and residents. The mean time to completion was 792.7 seconds (95% confidence interval, 623.4-962) for medical students and 659 seconds (95% confidence interval, 599.1-719) for residents (P = .118).
Dedicated instruction of fourth-year medical students with deliberate and distributed practice of microvascular techniques using a porcine end-to-side coronary artery anastomosis simulation model results in performance comparable to that of senior general surgery residents. These results suggest that focused tissue simulator training can compress the learning curve to acquire technical proficiency in comparison with real-time training.
本研究旨在评估在使用猪心模型进行冠状动脉吻合术方面，专门的指导和刻意练习对四年级医学生的熟练度的影响，与未接受模拟器培训的高年资普通外科住院医师相比。
10 名四年级医学生接受使用猪模拟器进行冠状动脉吻合术的培训。学生们使用刻意练习方法和一对一指导进行了 4 个月的培训。在培训结束时，每位学生都进行了完整吻合术的录像。11 名高年资普通外科住院医师在接受一次辅导后进行了吻合术的录像。所有的影片都由 3 位独立的心脏外科医生进行盲法评分。主要结局是改良的客观结构化技术技能评估量表的中位数最终评分（范围，1-10）。次要结局是完成时间（以秒为单位）。统计分析同时使用了参数（学生 t 检验）和非参数（Wilcoxon 秩和检验）方法。
医学生的中位数综合最终得分为 3（四分位距，2.3-4.8），而住院医师为 4（四分位距，3.3-5.3）（P=0.102）。1 位评分者的中位数个体最终评分分别为 3（四分位距，2-6），2 位评分者为 3（四分位距，2-5），3 位评分者为 4（四分位距，3-5）。对于每位个体评分者，医学生和住院医师的中位数最终评分无差异。医学生的平均完成时间为 792.7 秒（95%置信区间，623.4-962），住院医师为 659 秒（95%置信区间，599.1-719）（P=0.118）。
使用猪端侧冠状动脉吻合术模拟模型对四年级医学生进行专门的指导和刻意练习微血管技术，可使他们的表现与高年资普通外科住院医师相当。这些结果表明，与实时培训相比，有针对性的组织模拟器培训可以压缩学习曲线，以获得技术熟练程度。
