University of British Columbia, Vancouver, British Columbia, Canada.
University of British Columbia, Vancouver, British Columbia, Canada.
J Surg Educ. 2016 Jan-Feb;73(1):157-61. doi: 10.1016/j.jsurg.2015.09.004. Epub 2015 Dec 22.
Competency-based surgical education relies on operative models to teach surgical skills within a curriculum. Low fidelity simulation has been shown to improve surgical performance. Our objectives were: to develop procedure-specific models to teach anterior repair (AR), posterior repair (PR), and vaginal hysterectomy (VH) to junior residents; to establish model reliability and validity.
Residents were randomized to control (no training) and intervention (model training) groups. They were filmed while performing a series of tasks. Experts were also filmed. Each video was scored by 2 blinded raters.
Multicenter collaboration within the Western Society of Pelvic Medicine (Vancouver, Calgary, and Edmonton). Face and content validity were evaluated. A standard scoring tool was developed for performance evaluation. Interrater reliability was assessed using intraclass correlation coefficient. Cronbach α was calculated for internal consistency. Jonckheere-Terpstra test verified whether the scores increased with operator skill level.
A total of 14 junior gynecology residents, 2 urogynecology fellows, and 3 staff urogynecologists were rated by a total of 6 gynecologic surgeons who scored 42 videos each.
Experienced pelvic surgeons from 3 participating sites agreed the models captured essential elements of real surgical skills (face validity) and of the true procedures (content validity). Intraclass correlation coefficient was adequate (AR = 0.86, PR = 0.90, and VH = 0.87). Cronbach α for the total scores was adequate (AR = 0.85, PR = 0.8, and VH = 0.71). Performance score increased with operator skill level for all 3 procedures (AR, p = <0.001; PR, p = 0.008; and VH, p = 0.007).
Our low fidelity procedure-specific vaginal surgery models had adequate initial validity. Future research will investigate transferability of acquired skills to the operating room.
基于能力的外科教育依赖于手术模型来在课程中教授外科技能。低保真模拟已被证明可以提高手术表现。我们的目标是：为初级住院医师开发特定于程序的模型，以教授前修复（AR）、后修复（PR）和阴道子宫切除术（VH）；建立模型的可靠性和有效性。
住院医师随机分为对照组（无培训）和干预组（模型培训）。他们在执行一系列任务时被拍摄。专家也被拍摄。每个视频由 2 名盲评人评分。
温哥华、卡尔加里和埃德蒙顿的西方骨盆医学学会（Western Society of Pelvic Medicine）多中心合作。评估了表面和内容效度。为绩效评估制定了标准评分工具。使用组内相关系数评估了组内可靠性。计算 Cronbach α 以评估内部一致性。Jonckheere-Terpstra 检验验证了评分是否随操作人员技能水平的提高而增加。
共有 14 名初级妇科住院医师、2 名泌尿科研究员和 3 名主治泌尿科医生由总共 6 名妇科医生进行评估，每位医生对 42 个视频进行评分。
来自 3 个参与地点的有经验的盆腔外科医生一致认为，模型捕捉到了真实手术技能的基本要素（表面效度）和真实手术的基本要素（内容效度）。组内相关系数足够（AR = 0.86，PR = 0.90，VH = 0.87）。总分数的 Cronbach α 足够（AR = 0.85，PR = 0.8，VH = 0.71）。所有 3 种手术的操作技能水平越高，绩效评分越高（AR，p <0.001；PR，p = 0.008；VH，p = 0.007）。
我们的低保真特定于程序的阴道手术模型具有足够的初步有效性。未来的研究将调查所获得技能在手术室中的转移能力。
