超逼真的外周血管暴露和筋膜切开术物理模型能否替代尸体进行性能评估？
Can hyper-realistic physical models of peripheral vessel exposure and fasciotomy replace cadavers for performance assessment?
作者信息
Holzmacher Jeremy, Sarani Babak, Puche Adam, Granite Guinevere, Shalin Valerie, Pugh Kristy, Teeter William, Tisherman Samuel, Shackelford Stacy, Mackenzie Colin F
机构信息
From the George Washington University, Washington DC (J.H., B.S.); Shock Trauma Anesthesiology Research Center, Departments of Anatomy, Anesthesiology, Surgery, University of Maryland, Baltimore, Maryland (C.F.M. T.S., S.S., A.P. V.S., K.P., G.G., W.T.); Institute Surgical Research, San Antonio, TX.
出版信息
J Trauma Acute Care Surg. 2017 Jul;83(1 Suppl 1):S130-S135. doi: 10.1097/TA.0000000000001419.
BACKGROUND
Work-hour restrictions have reduced operative experience for residents. The Advanced Surgical Skills for Exposure in Trauma (ASSET) course fills this training gap. Cadaver use has limitations including cost and availability. Hyper-realistic synthetic models may provide an alternative to cadavers. We compared same surgeon performance between synthetic and cadaveric models to determine interchangeability for formative evaluation.
METHODS
Forty residents (<4 weeks after ASSET) and 35 faculty (mean, 2.5 ± 1.3 years after ASSET) exposed axillary, brachial, and femoral arteries, and performed lower extremity fasciotomy. Separate evaluators and random starting order between models were used for participants. Individual procedure scores and aggregate procedure scores, a trauma readiness index, evaluated participants. Student's t and χ tests were used where appropriate. p Values less than 0.05 were considered significant.
RESULTS
For same surgeons, faculty, but not residents, had higher trauma readiness index on the synthetic model (0.63 vs. 0.70, p < 0.01; 0.63 vs. 0.67, p = 0.06, respectively). Scores were not significantly different between models for residents except for the brachial artery exposure (0.68 vs. 0.75, p < 0.01), which was the least realistic of all procedures. Faculty did significantly better on the synthetic model in all procedures. All participants completed procedures nearly twice as quickly (5.61 ± 3.21 vs. 10.08 ± 4.66 minutes) and performed fewer errors on the synthetic model (113 vs. 53, p < 0.01; 118 vs. 76, p = 0.03, respectively).
CONCLUSION
Same surgeons performed procedures quicker and with fewer errors on the synthetic model. Residents performed similarly on both model types, this likely represents the unfamiliarity neophytes bring to new procedures. This suggests that the synthetic model, with easily discernible and standardized anatomy, may be useful in the early stages of training to understand critical procedural steps. The difficulty of the cadaver is more apt to assess and evaluate the experienced surgeon and identify opportunities for improvement.
LEVEL OF EVIDENCE
Prognostic, level III.
背景
工作时间限制减少了住院医师的手术经验。高级创伤暴露手术技能（ASSET）课程填补了这一培训空白。尸体使用存在包括成本和可用性在内的局限性。超逼真的合成模型可能为尸体提供一种替代方案。我们比较了合成模型和尸体模型上同一外科医生的表现，以确定用于形成性评估的互换性。
方法
40名住院医师（ASSET课程后<4周）和35名教员（ASSET课程后平均2.5±1.3年）暴露腋动脉、肱动脉和股动脉，并进行下肢筋膜切开术。参与者使用单独的评估者，模型之间采用随机起始顺序。通过个体手术得分和总体手术得分（一种创伤准备指数）对参与者进行评估。在适当情况下使用学生t检验和χ检验。p值小于0.05被认为具有统计学意义。
结果
对于同一外科医生，教员在合成模型上的创伤准备指数更高，但住院医师并非如此（分别为0.63对0.70，p<0.01；0.63对0.67，p=0.06）。除肱动脉暴露外，住院医师在两种模型上的得分无显著差异（0.68对0.75，p<0.01），肱动脉暴露是所有手术中最不逼真的。教员在合成模型上的所有手术中表现明显更好。所有参与者在合成模型上完成手术的速度几乎快了一倍（5.61±3.21对10.08±4.66分钟），且错误更少（分别为113对53，p<0.01；118对76，p=0.03）。
结论
同一外科医生在合成模型上进行手术更快且错误更少。住院医师在两种模型类型上的表现相似，这可能代表新手对新手术的不熟悉。这表明，具有易于辨别和标准化解剖结构的合成模型，在培训早期理解关键手术步骤方面可能有用。尸体模型的难度更适合评估和评价经验丰富的外科医生，并识别改进机会。
证据水平
预后性，III级。
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