From the Imperial College London (J.B.H.); and Department of Paediatric Surgery (V.P., M.H., S.C.), Chelsea and Westminster Hospital, London, UK.
Simul Healthc. 2013 Dec;8(6):376-81. doi: 10.1097/SIH.0b013e31829b3ff9.
Our aim was to design, create, and validate a simulator model and simulation scenario for the early management of gastroschisis.
Candidates of varying surgical experience had 1 attempt on an abdominal wall defect simulator and were scored for 4 different aspects: resuscitation of the neonate, application of a silo by both a global rating scale and a procedure-specific checklist, and nontechnical skills (scored by Non-Technical Skills scale). Surgical trainees subsequently received a focused teaching module on the resuscitative management and the surgical decision-making process, including bowel protection methods. Trainees then had a second attempt, which was objectively analyzed for improvement.
Candidates attempted the simulation and were assessed, looking for construct validity. There was a statistically significant difference between candidate experience levels for all aspects of the simulation (resuscitation, global rating scale, procedure-specific checklist, and nontechnical skills) calculated using analysis of variance. Feedback forms gave us face validity, with a mean adjusted score of 8.3/10 for realism. After teaching the module, there was a statistically significant improvement (P < 0.05) of 20% for technical skills and 10% for nontechnical skills, which is comparable with similar controlled studies.
We showed that creating and running a simulation scenario for the early management of gastroschisis is a feasible and useful tool for training and assessment. The simulation may also be able to discriminate between experience levels and could be used as a teaching aid to improve a surgeon's technical and nontechnical skills.
我们旨在设计、创建并验证一种用于先天性腹裂早期处理的模拟模型和模拟场景。
不同手术经验的候选者尝试使用腹壁缺陷模拟器 1 次，并根据 4 个不同方面进行评分：新生儿复苏、使用造口袋（使用综合评分和特定操作检查表），以及非技术技能（使用非技术技能量表）。随后，外科学员接受关于复苏管理和手术决策过程的集中教学模块，包括肠保护方法。学员进行第二次尝试，并对其进行客观分析以评估是否有进步。
候选者尝试模拟并接受评估，以寻找结构有效性。使用方差分析计算，候选者的模拟经验水平在所有模拟方面（复苏、综合评分、特定操作检查表和非技术技能）均存在统计学显著差异。反馈表为我们提供了表面有效性，其现实感的平均调整得分为 8.3/10。在教授模块后，技术技能和非技术技能分别有 20%和 10%的统计学显著提高（P<0.05），这与类似的对照研究相当。
我们表明，创建和运行用于先天性腹裂早期处理的模拟场景是培训和评估的一种可行且有用的工具。该模拟也可能能够区分经验水平，并可作为一种教学辅助工具来提高外科医生的技术和非技术技能。
