Moran-Atkin Erin, Abdalla Gamal, Chen Grace, Magnuson Thomas H, Lidor Anne O, Schweitzer Michael A, Steele Kimberley E
Department of Surgery, Johns Hopkins University School of Medicine, Suite 399, 4940 Eastern Ave 21224, Baltimore, MD, 21287, USA,
Surg Endosc. 2015 May;29(5):1057-63. doi: 10.1007/s00464-014-3778-1. Epub 2014 Sep 24.
The ACGME has required that a skills lab be incorporated into the surgical residency curriculum. While the value of warm-up is generally accepted in other areas requiring complex motor skills, there is little evidence to support the benefits of warm-up prior to performing surgery. We are conducting this study in an attempt to identify whether a warm-up period prior to operating impacts operative technique.
All general surgery residents and MIS fellows were included in this IRB-approved randomized study. Participants were randomized to either warm-up or no warm-up groups. Participants randomized to the warm-up group completed a 10 min practice session in the simulation lab within 1 h of starting the case, using an FLS training box. At the conclusion of the operation, the participant was evaluated by the attending surgeon using the validated global rating scales of Reznick and Vassiliou. The attending surgeons were blinded to the use of pre-procedure warm-up. The results of the questionnaire were analyzed using student's t test with p < 0.05 for significance.
Pilot data were obtained after completing 40 cases that were randomized to warm-up (19) or no warm-up (21). There was a statistically significant improvement in depth perception (p = 0.02), bimanual dexterity (p = 0.01), and efficiency of movements (p = 0.03) for those randomized to warm-up. There was statistical improvement when we preformed a composite scoring of the attending evaluations for each of the Reznick (p = 0.008) and the Vassiliou (p = 0.01) global rating scales.
Preoperative warm-up significantly improves depth perception, bimanual dexterity, and efficiency of movements, as well as improvement in composite scores as judged by the attending surgeon. The lack of self-perceived improvement by the residents may be a reflection of the high standards and intense self-critique that is common among surgical trainees. We believe that our findings, while preliminary, reflect that surgical performance can be enhanced through structured warm-up activities.
美国研究生医学教育认证委员会（ACGME）要求在外科住院医师培训课程中纳入技能实验室。虽然在其他需要复杂运动技能的领域，热身的价值已得到普遍认可，但几乎没有证据支持手术前进行热身的益处。我们开展这项研究，旨在确定手术前的热身期是否会影响手术操作技术。
本项经机构审查委员会（IRB）批准的随机研究纳入了所有普通外科住院医师和微创外科研究员。参与者被随机分为热身组或无热身组。被随机分配到热身组的参与者在病例开始后1小时内，使用FLS训练箱在模拟实验室完成10分钟的练习环节。手术结束时，主刀医生使用经过验证的Reznick和Vassiliou整体评分量表对参与者进行评估。主刀医生对术前热身的使用情况不知情。问卷结果采用学生t检验进行分析，p < 0.05为有统计学意义。
在完成40例随机分为热身组（19例）或无热身组（21例）的病例后，获得了初步数据。对于被随机分配到热身组的参与者，其深度感知（p = 0.02）、双手灵活性（p = 0.01）和动作效率（p = 0.03）有统计学意义的改善。当我们对Reznick（p = 0.008）和Vassiliou（p = 0.01）整体评分量表的主刀评估进行综合评分时，有统计学上的改善。
术前热身显著提高了深度感知、双手灵活性和动作效率，以及主刀医生判断的综合评分。住院医师缺乏自我感知的改善可能反映了外科实习生中常见的高标准和强烈的自我批评。我们认为，我们的研究结果虽然是初步的，但反映出通过有组织的热身活动可以提高手术表现。
