Egol Kenneth A, Phillips Donna, Vongbandith Tom, Szyld Demian, Strauss Eric J
Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, United States.
Department of Orthopaedic Surgery, NYU Langone Medical Center, United States.
Injury. 2015 Apr;46(4):547-51. doi: 10.1016/j.injury.2014.10.061. Epub 2014 Nov 18.
We hypothesized that resident participation in a hands-on fracture fixation course leads to significant improvement in their performance as assessed in a simulated fracture fixation model.
Twenty-three junior orthopaedic surgery residents were tasked to treat radial shaft fractures with standard fixation techniques in a sawbones fracture fixation simulation twice during the year. Before the first simulation, 6 of the residents participated in a fraction fixation skills course. The simulation repeated 6 months later after all residents attended the course. Residents also completed a 15-question written examination. Assessment included evaluation of each step of the procedure, a score based on the objective structured assessment of technical skill (OSATS) system, and grade on the examination. Comparisons were made between the two cohorts and the two testing time points.
Significant improvements were present in the percentage of tasks completed correctly (64.1% vs 84.3%) the overall OSATS score (13.8 vs 17.1) and examination correct answers (8.6 vs 12.5) for the overall cohort between the two testing time points (p<0.001, p<0.03, p<0.04 respectively). Residents who had not participated in the surgical skills course at the time of their initial simulation demonstrated significant improvements in percentage of tasks completed correctly (61.3% vs 81.2%) and OSATS score (12.4 vs 17.0) (p<0.002, p<0.01 respectively). No significant difference was noted in performance for the cohort who had already participated in the course (p=0.87 and p=0.68). The cohort that had taken the course prior to the initial simulation showed significantly higher scores at initial evaluation (88.5% vs 58.5% percentage of tasks completed correctly, 17.3 vs 12.0 OSATS score, 12.5 vs 8.6 correct answers on the examination). At the second simulation, no significant difference was seen with task completion or examination grade, but a significant difference still existed with respect to the OSATS score (20.0 vs 17.0; p<0.03).
Participation in a formal surgical skills course significantly improved practical operative skills as assessed by the simulation. The benefits of the course were maintained to 6 months with residents who completed the training earlier continuing to demonstrate an advantage in skills. Such courses are a valuable training resource which directly impact resident performance.
我们假设住院医师参与实践骨折固定课程后，在模拟骨折固定模型中评估其表现会有显著改善。
23名骨科初级住院医师在一年内两次使用标准固定技术在人工骨骨折固定模拟中治疗桡骨干骨折。在第一次模拟前，6名住院医师参加了骨折固定技能课程。所有住院医师参加课程6个月后重复模拟。住院医师还完成了一份15道题的书面考试。评估包括对手术步骤的每一步进行评价、基于客观结构化技术技能评估（OSATS）系统的评分以及考试成绩。对两组以及两个测试时间点进行了比较。
在两个测试时间点之间，整个队列正确完成任务的百分比（64.1%对84.3%）、总体OSATS评分（13.8对17.1）和考试正确答案数（8.6对12.5）均有显著提高（分别为p<0.001、p<0.03、p<0.04）。在初次模拟时未参加手术技能课程的住院医师在正确完成任务的百分比（61.3%对81.2%）和OSATS评分（12.4对17.0）方面有显著提高（分别为p<0.002、p<0.01）。已参加课程的队列在表现上没有显著差异（p = 0.87和p = 0.68）。在初次模拟前参加课程的队列在初次评估时得分显著更高（正确完成任务的百分比88.5%对58.5%，OSATS评分17.3对12.0，考试正确答案数12.5对8.6）。在第二次模拟时，任务完成情况或考试成绩没有显著差异，但在OSATS评分方面仍存在显著差异（20.0对17.0；p<0.03）。
参加正式的手术技能课程可显著提高模拟评估的实际操作技能。课程的益处持续到6个月，早期完成培训的住院医师在技能方面继续表现出优势。此类课程是直接影响住院医师表现的宝贵培训资源。
