Ghanem Ali M, Hachach-Haram Nadine, Leung Clement Chi Ming, Myers Simon Richard
Academic Plastic Surgery Group, Centre for Cutaneous Research, Barts and the London School of Medicine and Dentistry, London, UK.
Arch Plast Surg. 2013 Jul;40(4):312-9. doi: 10.5999/aps.2013.40.4.312. Epub 2013 Jul 17.
Over the past decade, driven by advances in educational theory and pressures for efficiency in the clinical environment, there has been a shift in surgical education and training towards enhanced simulation training. Microsurgery is a technical skill with a steep competency learning curve on which the clinical outcome greatly depends. This paper investigates the evidence for educational and training interventions of traditional microsurgical skills courses in order to establish the best evidence practice in education and training and curriculum design. A systematic review of MEDLINE, EMBASE, and PubMed databases was performed to identify randomized control trials looking at educational and training interventions that objectively improved microsurgical skill acquisition, and these were critically appraised using the BestBETs group methodology. The databases search yielded 1,148, 1,460, and 2,277 citations respectively. These were then further limited to randomized controlled trials from which abstract reviews reduced the number to 5 relevant randomised controlled clinical trials. The best evidence supported a laboratory based low fidelity model microsurgical skills curriculum. There was strong evidence that technical skills acquired on low fidelity models transfers to improved performance on higher fidelity human cadaver models and that self directed practice leads to improved technical performance. Although there is significant paucity in the literature to support current microsurgical education and training practices, simulated training on low fidelity models in microsurgery is an effective intervention that leads to acquisition of transferable skills and improved technical performance. Further research to identify educational interventions associated with accelerated skill acquisition is required.
在过去十年中，受教育理论进步以及临床环境对效率的要求的推动，外科教育与培训已转向强化模拟训练。显微外科是一项技术技能，其能力学习曲线陡峭，临床结果在很大程度上取决于此。本文研究传统显微外科技能课程教育与培训干预措施的证据，以便确立教育、培训及课程设计方面的最佳循证实践。对MEDLINE、EMBASE和PubMed数据库进行了系统综述，以识别着眼于客观提高显微外科技能习得的教育与培训干预措施的随机对照试验，并使用BestBETs小组方法对这些试验进行严格评估。数据库检索分别产生了1148条、1460条和2277条引文。然后将这些进一步限定为随机对照试验，通过摘要评审将数量减少至5项相关随机对照临床试验。最佳证据支持基于实验室的低保真模型显微外科技能课程。有强有力的证据表明，在低保真模型上获得的技术技能可转化为在高保真人体尸体模型上的更好表现，且自主练习可提高技术表现。尽管文献中严重缺乏支持当前显微外科教育与培训实践的内容，但显微外科低保真模型模拟训练是一种有效的干预措施，可带来可转移技能的习得和技术表现的提升。需要进一步研究以确定与加速技能习得相关的教育干预措施。
