Schwartz Samuel, de Virgilio Michael, Chisum Patrick, Heslin Andrew, Zein Alyssar, McDermott Meilu, Kaji Amy, Yaghoubian Arezou, de Virgilio Christian
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA.
Department of Surgery, Harbor-UCLA Medical Center, Torrance, CA; Department of Emergency Medicine, Harbor-UCLA Medical Center, Torrance, CA.
Ann Vasc Surg. 2014 Jul;28(5):1087-93. doi: 10.1016/j.avsg.2013.10.018. Epub 2014 Jan 10.
Laboratory skills training is now required for general surgery residents. The optimal method of teaching vascular anastomosis (VA) is not well defined. Teaching VA skills one-on-one with a faculty instructor will result in a more rapid accumulation of skills than teaching in a large group setting.
Residents were shown an instructional video on how to perform a VA using a standardized model (cadaver saphenous vein and porcine aorta). Each resident then performed a baseline VA. Sixteen first- and second-year surgical residents were then randomized to 2 VA teaching sessions that consisted of either 1) group teaching (GT, 8 residents in a room with 1 faculty instructor circulating) or 2) one-on-one teaching (1-on-1, faculty member focused on individual resident). After each of these sessions, residents performed a standardized VA. The anastomoses were video recorded. Performance was evaluated using a standardized scoring system by a separate expert who viewed the video recordings in a blinded fashion. Outcome measures included total errors, total time, global rating scale, and an anastomosis-specific end-product evaluation (leak and passage of coronary dilator).
Overall, significant decreases in total errors (21 to 15, P=0.001) and time to complete anastomoses (42 to 38 min, P=0.02) and an increase in global rating scales (7 to 11, P=0.003) were noted in both groups from baseline after 2 VA teaching session. The 1-on-1 group demonstrated significantly greater improvement in terms of reduced anastomotic time (30 vs. 42 min, P=0.007) and in reduction of errors (13 vs. 19 errors, P=0.09) than the GT group.
The high-fidelity VA model is a useful tool for junior general surgery residents. Both GT and 1-on-1 groups demonstrated significant improvement in total errors and time after only 2 sessions. Greater improvement was noted using the 1-on-1 model.
普通外科住院医师现在需要进行实验室技能培训。血管吻合术（VA）的最佳教学方法尚未明确界定。与教员一对一教授VA技能比在大组环境中教学能使技能积累得更快。
向住院医师展示一个关于如何使用标准化模型（尸体隐静脉和猪主动脉）进行VA的教学视频。然后每位住院医师进行一次基线VA操作。16名第一年和第二年的外科住院医师随后被随机分为两组VA教学课程，分别为：1）小组教学（GT，8名住院医师在一个房间，有1名教员巡回指导）或2）一对一教学（1对1，教员专注于单个住院医师）。在每节课程结束后，住院医师进行一次标准化VA操作。吻合过程进行视频记录。由另一位独立专家以盲法观看视频记录，使用标准化评分系统对操作表现进行评估。结果指标包括总错误数、总时间、整体评分量表以及特定于吻合术的最终产品评估（渗漏和冠状动脉扩张器通过情况）。
总体而言，两组在经过2次VA教学课程后，与基线相比，总错误数（从21降至15，P = 0.001）和完成吻合的时间（从42分钟降至38分钟，P = 0.02）均显著减少，整体评分量表得分增加（从7升至11，P = 0.003）。一对一教学组在减少吻合时间（30分钟对42分钟，P = 0.007）和减少错误数（13个对19个错误，P = 0.09）方面比小组教学组有显著更大的改善。
高保真VA模型是初级普通外科住院医师的有用工具。小组教学组和一对一教学组在仅2节课程后总错误数和时间方面均有显著改善。使用一对一模型观察到更大的改善。
