De Win Gunter, Van Bruwaene Siska, Kulkarni Jyotsna, Van Calster Ben, Aggarwal Rajesh, Allen Christopher, Lissens Ann, De Ridder Dirk, Miserez Marc
Department of Urology, Antwerp University Hospital; Faculty of Health Sciences, University of Antwerp, Antwerp.
Department of Urology, University Hospitals of KU Leuven; Centre for Surgical Technologies, KU Leuven, Leuven, Belgium.
Adv Med Educ Pract. 2016 Jun 30;7:357-70. doi: 10.2147/AMEP.S102000. eCollection 2016.
Surgical simulation is becoming increasingly important in surgical education. However, the method of simulation to be incorporated into a surgical curriculum is unclear. We compared the effectiveness of a proficiency-based preclinical simulation training in laparoscopy with conventional surgical training and conventional surgical training interspersed with standard simulation sessions.
In this prospective single-blinded trial, 30 final-year medical students were randomized into three groups, which differed in the way they were exposed to laparoscopic simulation training. The control group received only clinical training during residency, whereas the interval group received clinical training in combination with simulation training. The Center for Surgical Technologies Preclinical Training Program (CST PTP) group received a proficiency-based preclinical simulation course during the final year of medical school but was not exposed to any extra simulation training during surgical residency. After 6 months of surgical residency, the influence on the learning curve while performing five consecutive human laparoscopic cholecystectomies was evaluated with motion tracking, time, Global Operative Assessment of Laparoscopic Skills, and number of adverse events (perforation of gall bladder, bleeding, and damage to liver tissue).
The odds of adverse events were 4.5 (95% confidence interval 1.3-15.3) and 3.9 (95% confidence interval 1.5-9.7) times lower for the CST PTP group compared with the control and interval groups. For raw time, corrected time, movements, path length, and Global Operative Assessment of Laparoscopic Skills, the CST PTP trainees nearly always started at a better level and were never outperformed by the other trainees.
Proficiency-based preclinical training has a positive impact on the learning curve of a laparoscopic cholecystectomy and diminishes adverse events.
手术模拟在外科教育中变得越来越重要。然而，将模拟方法纳入外科课程的方式尚不清楚。我们比较了基于熟练程度的临床前腹腔镜模拟训练与传统外科训练以及穿插标准模拟课程的传统外科训练的效果。
在这项前瞻性单盲试验中，30名医学专业最后一年的学生被随机分为三组，他们接受腹腔镜模拟训练的方式不同。对照组在住院医师培训期间仅接受临床训练，而间隔组接受临床训练与模拟训练相结合的方式。外科技术中心临床前培训项目（CST PTP）组在医学院最后一年接受基于熟练程度的临床前模拟课程，但在外科住院医师培训期间未接受任何额外的模拟训练。在外科住院医师培训6个月后，通过动作追踪、时间、腹腔镜技能全球手术评估以及不良事件（胆囊穿孔、出血和肝组织损伤）数量来评估连续进行五次人体腹腔镜胆囊切除术时对学习曲线的影响。
与对照组和间隔组相比，CST PTP组不良事件的几率分别低4.5倍（95%置信区间1.3 - 15.3）和3.9倍（95%置信区间1.5 - 9.7）。对于原始时间、校正时间、动作、路径长度和腹腔镜技能全球手术评估，CST PTP组的学员几乎总是从更好的水平开始，并且从未被其他学员超越。
基于熟练程度的临床前训练对腹腔镜胆囊切除术的学习曲线有积极影响，并减少不良事件。
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