Ferrarese Alessia, Gentile Valentina, Bindi Marco, Rivelli Matteo, Cumbo Jacopo, Solej Mario, Enrico Stefano, Martino Valter
Department of Oncology, University of Turin, Section of General Surgery, San Luigi Gonzaga Teaching Hospital, Regione Gonzole 10, 10043 Orbassano, Turin, Italy.
University of Turin, Department of Oncology, School of Medicine, Teaching Hospital "San Luigi Gonzaga", Section of General Surgery, Orbassano, Turin, Italy.
Open Med (Wars). 2016 Nov 26;11(1):489-496. doi: 10.1515/med-2016-0086. eCollection 2016.
A well-designed learning curve is essential for the acquisition of laparoscopic skills: but, are there risk factors that can derail the surgical method? From a review of the current literature on the learning curve in laparoscopic surgery, we identified learning curve components in video laparoscopic cholecystectomy; we suggest a learning curve model that can be applied to assess the progress of general surgical residents as they learn and master the stages of video laparoscopic cholecystectomy regardless of type of patient. Electronic databases were interrogated to better define the terms "surgeon", "specialized surgeon", and "specialist surgeon"; we surveyed the literature on surgical residency programs outside Italy to identify learning curve components, influential factors, the importance of tutoring, and the role of reference centers in residency education in surgery. From the definition of acceptable error, self-efficacy, and error classification, we devised a learning curve model that may be applied to training surgical residents in video laparoscopic cholecystectomy. Based on the criteria culled from the literature, the three surgeon categories (general, specialized, and specialist) are distinguished by years of experience, case volume, and error rate; the patients were distinguished for years and characteristics. The training model was constructed as a series of key learning steps in video laparoscopic cholecystectomy. Potential errors were identified and the difficulty of each step was graded using operation-specific characteristics. On completion of each procedure, error checklist scores on procedure-specific performance are tallied to track the learning curve and obtain performance indices of measurement that chart the trainee's progress.
The concept of the learning curve in general surgery is disputed. The use of learning steps may enable the resident surgical trainee to acquire video laparoscopic cholecystectomy skills proportional to the instructor's ability, the trainee's own skills, and the safety of the surgical environment. There were no patient characteristics that can derail the methods. With this training scheme, resident trainees may be provided the opportunity to develop their intrinsic capabilities without the loss of basic technical skills.
精心设计的学习曲线对于掌握腹腔镜手术技能至关重要：但是，是否存在会使手术方法偏离正轨的风险因素呢？通过回顾当前关于腹腔镜手术学习曲线的文献，我们确定了视频腹腔镜胆囊切除术中学习曲线的组成部分；我们提出了一种学习曲线模型，该模型可用于评估普通外科住院医师在学习和掌握视频腹腔镜胆囊切除术各阶段时的进展情况，而不论患者类型如何。对电子数据库进行查询，以更好地定义“外科医生”“专科外科医生”和“专家外科医生”等术语；我们调查了意大利以外国家外科住院医师培训项目的文献，以确定学习曲线的组成部分、影响因素、辅导的重要性以及参考中心在外科住院医师培训中的作用。根据可接受误差、自我效能和误差分类的定义，我们设计了一种学习曲线模型，可应用于培训外科住院医师进行视频腹腔镜胆囊切除术。根据从文献中筛选出的标准，将三类外科医生（普通、专科和专家）按经验年限、病例数量和错误率进行区分；患者则按年份和特征进行区分。该培训模型被构建为视频腹腔镜胆囊切除术中一系列关键的学习步骤。识别出潜在错误，并根据特定手术特征对每个步骤的难度进行分级。在完成每个手术后，统计特定手术操作的错误清单分数，以跟踪学习曲线并获得衡量学员进展的性能指标。
普通外科中学习曲线的概念存在争议。使用学习步骤可能使住院医师培训学员获得与指导教师能力、学员自身技能以及手术环境安全性相称的视频腹腔镜胆囊切除术技能。不存在会使手术方法偏离正轨的患者特征。通过这种培训方案，住院医师培训学员可能有机会发展其内在能力，而不会丧失基本技术技能。
