Pugh Carla M, Arafat Fahd O, Kwan Calvin, Cohen Elaine R, Kurashima Yo, Vassiliou Melina C, Fried Gerald M
Department of Surgery, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53792, USA.
Department of Surgery, Northwestern University, Chicago, IL, USA.
Am J Surg. 2015 Oct;210(4):603-9. doi: 10.1016/j.amjsurg.2015.05.034. Epub 2015 Aug 14.
The aim of our study was to modify our previously developed laparoscopic ventral hernia (LVH) simulator to increase difficulty and then reassess validity and feasibility for using the simulator in a newly developed simulation-based continuing medical education course.
Participants (N = 30) were practicing surgeons who signed up for a hands-on postgraduate laparoscopic hernia course. An LVH simulator, with prior validity evidence, was modified for the course to increase difficulty. Participants completed 1 of the 3 variations in hernia anatomy: incarcerated omentum, incarcerated bowel, and diffuse adhesions. During the procedure, course faculty and peer observers rated surgeon performance using Global Operative Assessment of Laparoscopic Skills-Incisional Hernia and Global Operative Assessment of Laparoscopic Skills rating scales with prior validity evidence. Rating scale reliability was reassessed for internal consistency. Peer and faculty raters' scores were compared. In addition, quality and completeness of the hernia repairs were rated.
Internal consistency on the general skills performance (peer α = .96, faculty α = .94) and procedure-specific performance (peer α = .91, faculty α = .88) scores were high. Peers were more lenient than faculty raters on all LVH items in both the procedure-specific skills and general skills ratings. Overall, participants scored poorly on the quality and completeness of their hernia repairs (mean = 3.90/16, standard deviation = 2.72), suggesting a mismatch between course attendees and hernia difficulty and identifying a learning need.
Simulation-based continuing medical education courses provide hands-on experiences that can positively affect clinical practice. Although our data appear to show a significant mismatch between clinical skill and simulator difficulty, these findings also underscore significant learning needs in the surgical community.
我们研究的目的是对我们之前开发的腹腔镜腹疝（LVH）模拟器进行改进以增加难度，然后重新评估在新开发的基于模拟的继续医学教育课程中使用该模拟器的有效性和可行性。
参与者（N = 30）为报名参加实践型研究生腹腔镜疝修补课程的外科医生。对具有先前有效性证据的LVH模拟器进行了改进以增加课程难度。参与者完成了3种疝解剖变异中的1种：大网膜嵌顿、肠管嵌顿和广泛粘连。在手术过程中，课程教员和同行观察员使用具有先前有效性证据的腹腔镜技能切口疝全球手术评估量表和腹腔镜技能全球手术评估量表对手术医生的表现进行评分。重新评估评分量表的内部一致性可靠性。比较同行和教员评分者的分数。此外，对疝修补的质量和完整性进行评分。
一般技能表现（同行α = 0.96，教员α = 0.94）和特定手术表现（同行α = 0.91，教员α = 0.88）分数的内部一致性较高。在特定手术技能和一般技能评分的所有LVH项目上，同行比教员评分者更宽松。总体而言，参与者在疝修补的质量和完整性方面得分较低（平均 = 3.90/16，标准差 = 2.72），这表明课程参与者与疝的难度不匹配，并确定了学习需求。
基于模拟的继续医学教育课程提供了可以对临床实践产生积极影响的实践经验。虽然我们的数据似乎显示临床技能与模拟器难度之间存在显著不匹配，但这些发现也凸显了外科界存在的重大学习需求。
Zotero 插件