Plastic and Reconstructive Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California 90033, USA.
J Surg Educ. 2013 Jul-Aug;70(4):466-74. doi: 10.1016/j.jsurg.2013.02.008. Epub 2013 Apr 30.
As interest in surgical simulation grows, plastic surgical educators are pressed to provide realistic surgical experience outside of the operating suite. Simulation models of plastic surgery procedures have been developed, but they are incomparable to the dissection of fresh tissue. We evolved a fresh tissue dissection (FTD) and simulation program with emphasis on surgical technique and simulation of clinical surgery. We hypothesized that resident confidence could be improved by adding FTD to our resident curriculum.
Over a 5-year period, FTD was incorporated into the curriculum. Participants included clinical medical students, postgraduate year 1 to 7 residents, and attending surgeons. Participants performed dissections and procedures with structured emphasis on anatomical detail, surgical technique, and rehearsal of operative sequence. Resident confidence was evaluated using retrospective pretest and posttest analysis with a 5-point scale, ranging from 1 (least confident) to 5 (most confident). Confidence was evaluated according to postgraduate year level, anatomical region, and procedure.
A total of 103 dissection days occurred, and a total of 192 dissections were reported, representing 73 different procedures. Overall, resident predissection confidence was 1.90±1.02 and postdissection confidence was 4.20±0.94 (p<0.001). The average increase in confidence correlated with training year, such that senior residents had greater gains. When compared by anatomical region, confidence was lowest for the head and neck region. When compared by procedure, confidence was lowest for rhinoplasty and face-lift, and highest for radial forearm and latissimus flaps.
A high-volume FTD experience was successfully incorporated into the residency program over 5 years. Training with FTD improves resident confidence, and this effect increases with seniority of training. Although initial data demonstrate that resident confidence is improved with FTD, additional evaluation is needed to establish objective evidence that patient outcomes and surgical quality can be improved with FTD.
随着对外科模拟的兴趣日益浓厚，整形外科教育工作者迫切需要在手术室之外提供真实的手术体验。已经开发出了整形外科手术的模拟模型，但它们无法与新鲜组织的解剖相媲美。我们开发了一种新鲜组织解剖（FTD）和模拟程序，重点是手术技术和模拟临床手术。我们假设通过在我们的住院医师课程中增加 FTD，可以提高住院医师的信心。
在 5 年的时间里，FTD 被纳入课程。参与者包括临床医学生、1 至 7 年级住院医师和主治外科医生。参与者进行解剖和手术，重点是解剖细节、手术技术和手术顺序的排练。使用 5 分制的回顾性前测和后测分析评估住院医师的信心，1 分表示最不自信，5 分表示最自信。根据住院医师的年级、解剖区域和手术程序评估信心。
共进行了 103 个解剖日，共报告了 192 次解剖，代表了 73 种不同的手术。总体而言，住院医师术前的信心评分为 1.90±1.02，术后的信心评分为 4.20±0.94（p<0.001）。信心的平均增加与培训年限相关，高级住院医师的收益更大。按解剖区域比较，头颈部的信心最低。按手术程序比较，隆鼻和面部提升的信心最低，桡侧前臂和Latissimus 皮瓣的信心最高。
在 5 年内，成功地将大量 FTD 经验纳入住院医师培训计划。使用 FTD 进行培训可以提高住院医师的信心，这种效果随着培训年限的增加而增加。尽管初步数据表明 FTD 可以提高住院医师的信心，但还需要进一步评估，以确定 FTD 是否可以改善患者结局和手术质量的客观证据。
