Miyasaka Kiyoyuki W, Buchholz Joseph, LaMarra Denise, Karakousis Giorgos C, Aggarwal Rajesh
Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania.
J Surg Educ. 2015 Jul-Aug;72(4):625-35. doi: 10.1016/j.jsurg.2015.01.017. Epub 2015 Apr 11.
Contemporary demands on resident education call for integration of simulation. We designed and implemented a simulation-based curriculum for Post Graduate Year 1 surgery residents to teach technical and nontechnical skills within a clinical pathway approach for a foregut surgery patient, from outpatient visit through surgery and postoperative follow-up.
The 3-day curriculum for groups of 6 residents comprises a combination of standardized patient encounters, didactic sessions, and hands-on training. The curriculum is underpinned by a summative simulation "pathway" repeated on days 1 and 3. The "pathway" is a series of simulated preoperative, intraoperative, and postoperative encounters in following up a single patient through a disease process. The resident sees a standardized patient in the clinic presenting with distal gastric cancer and then enters an operating room to perform a gastrojejunostomy on a porcine tissue model. Finally, the resident engages in a simulated postoperative visit. All encounters are rated by faculty members and the residents themselves, using standardized assessment forms endorsed by the American Board of Surgery.
A total of 18 first-year residents underwent this curriculum. Faculty ratings of overall operative performance significantly improved following the 3-day module. Ratings of preoperative and postoperative performance were not significantly changed in 3 days. Resident self-ratings significantly improved for all encounters assessed, as did reported confidence in meeting the defined learning objectives.
Conventional surgical simulation training focuses on technical skills in isolation. Our novel "pathway" curriculum targets an important gap in training methodologies by placing both technical and nontechnical skills in their clinical context as part of managing a surgical patient. Results indicate consistent improvements in assessments of performance as well as confidence and support its continued usage to educate surgery residents in foregut surgery.
当代对住院医师教育的要求促使模拟教学的融入。我们为一年级外科住院医师设计并实施了基于模拟的课程，以临床路径的方式教授前肠手术患者从门诊就诊到手术及术后随访过程中的技术和非技术技能。
为期3天的课程面向每组6名住院医师，包括标准化患者问诊、理论授课和实践培训。该课程以在第1天和第3天重复进行的总结性模拟“路径”为支撑。“路径”是一系列模拟的术前、术中和术后问诊，用于跟踪单个患者在疾病过程中的情况。住院医师在诊所接待一位表现为远端胃癌的标准化患者，然后进入手术室在猪组织模型上进行胃空肠吻合术。最后，住院医师进行模拟术后随访。所有问诊均由教员和住院医师本人使用美国外科委员会认可的标准化评估表进行评分。
共有18名一年级住院医师参加了该课程。在为期3天的课程模块结束后，教员对整体手术表现的评分显著提高。术前和术后表现的评分在3天内没有显著变化。住院医师对所有评估问诊的自我评分显著提高，对实现既定学习目标的信心也显著增强。
传统的外科模拟培训侧重于孤立地培养技术技能。我们新颖的“路径”课程通过将技术和非技术技能置于临床背景中，作为管理手术患者的一部分，填补了培训方法中的一个重要空白。结果表明在表现评估以及信心方面都有持续的提升，并支持继续使用该课程来对外科住院医师进行前肠手术的教育。
