School of Medicine, Universidade Positivo, Rua Prof. Pedro Viriato Parigot de Souza, 5300, Post-Graduation Building, Curitiba, 81280-330, Brazil.
Jacques Perissat Institute, Curitiba, Brazil.
Surg Endosc. 2017 Oct;31(10):4051-4057. doi: 10.1007/s00464-017-5451-y. Epub 2017 Feb 24.
Minimally invasive surgery (MIS) requires the mastery of manual skills and a specific training is required. Apart from residencies and fellowships in MIS, other learning opportunities utilize massive training, mainly with use of simulators in short courses. A long-term postgraduate course represents an opportunity to learn through training using distributed practice.
The objective of this study is to assess the use of distributed practice for acquisition of basic minimally invasive skills in surgeons who participated in a long-term MIS postgraduate course.
A prospective, longitudinal and quantitative study was conducted among surgeons who attended a 1-year postgraduate course of MIS in Brazil, from 2012 to 2014. They were tested through five different exercises in box trainers (peg-transfer, passing, cutting, intracorporeal knot, and suture) in the first (t0), fourth (t1) and last, eighth, (t2) meetings of this course. The time and penalties of each exercise were collected for each participant. Participant skills were assessed based on time and accuracy on a previously tested score.
Fifty-seven surgeons (participants) from three consecutive groups participated in this study. There was a significant improvement in scores in all exercises. The average increase in scores between t0 and t2 was 88% for peg-transfer, 174% for passing, 149% for cutting, 130% for intracorporeal knot, and 120% for suture (p < 0.001 for all exercises).
Learning through distributed practice is effective and should be integrated into a MIS postgraduate course curriculum for acquisition of core skills.
微创手术（MIS）需要掌握手工技能，并且需要进行专门的培训。除了 MIS 的住院医师培训和研究员培训外，其他学习机会主要利用模拟器进行短期课程培训，以获得大量的培训。长期研究生课程代表了通过使用分布式实践进行培训来学习的机会。
本研究旨在评估在参加长期微创外科研究生课程的外科医生中，使用分布式实践来获得基本微创技能的效果。
在巴西进行了一项前瞻性、纵向和定量研究，参与者为参加 2012 年至 2014 年为期 1 年的微创外科研究生课程的外科医生。他们在第一个（t0）、第四个（t1）和最后一个，第八个（t2）会议上，在盒子训练器（转移、传递、切割、腔内打结和缝合）上进行了五次不同的练习，记录每个参与者的每个练习的时间和罚分。根据参与者之前测试的分数，评估参与者的技能表现，包括时间和准确性。
三个连续组的 57 名外科医生（参与者）参加了这项研究。所有练习的分数都有显著提高。t0 与 t2 之间，转移练习的平均分数提高了 88%，传递练习提高了 174%，切割练习提高了 149%，腔内打结练习提高了 130%，缝合练习提高了 120%（所有练习均 p<0.001）。
分布式实践学习是有效的，应纳入微创外科研究生课程核心技能的获取中。
