Bartline Peter B, O'Shea Jennie, McGreevy James M, Mueller Michelle T
Vascular Surgery, University of Wisconsin-Madison, Madison, Wisc.
Trident Health Resources, University of Utah, Salt Lake City, Utah.
J Vasc Surg. 2017 Aug;66(2):642-648.e4. doi: 10.1016/j.jvs.2017.01.049. Epub 2017 May 12.
OBJECTIVE: This report describes a novel simulator, euthanized pigs on cardiopulmonary bypass, and validates this simulator with a controlled trial in general surgery residents learning aortic anastomosis. We evaluated this novel simulator with the following hypothesis: our porcine perfused simulator is as good as or better than the standard rubber tubing, low-fidelity models used for vascular anastomotic training. METHODS: Euthanized pigs were placed on cardiopulmonary bypass, creating a perfused, ex vivo model on which to perform surgical procedures. The participants in the study were postgraduate year 2, 3, and 4 general surgery residents. Residents were randomized to practice aortic anastomosis in the pig laboratory (PL) simulator or in a dry laboratory. The PL residents and control residents performed a first vascular anastomosis on the rubber tube model. Anastomosis creation was filmed. The anastomosis and video were stored for later grading. Next, all residents underwent an ungraded, one-on-one training session with the attending vascular surgeon. After the training session, all residents completed a second videotaped rubber tubing anastomosis. The grading scales used were validated by other authors: Global Assessment Score, Final Product Score, and Checklist Scoring Instrument. Survey data describing this experience were collected using a 13-question prelaboratory and 16-question postlaboratory questionnaires consisting of yes/no, multiple selection, and 5-point Likert-type scale questions. RESULTS: All residents had a statistically significant improvement in time to completion and in the Global Assessment Score with tutored practice. The PL residents showed statistically significant improvement in completion time between the first and second videotaped anastomosis; however, there was no statistically significant improvement in the scoring metrics. The control residents showed statistically significant improvement in all three scoring metrics, but no statistically significant difference was found in completion time. The survey data showed a statistically significant shift in considering vascular surgery as a career after the experience in the PL group (P = .05) compared with the control group, who had no change in interest (P = .91). CONCLUSIONS: Our prospective, randomized clinical trial shows that the porcine cardiopulmonary bypass model achieves similar results to a previously validated bench top model while improving general surgery resident interest in vascular surgery as a career.
目的:本报告介绍了一种新型模拟器——体外循环下的安乐死猪,并通过一项针对普通外科住院医师学习主动脉吻合术的对照试验对该模拟器进行验证。我们基于以下假设对这种新型模拟器进行评估:我们的猪灌注模拟器与用于血管吻合训练的标准橡胶管、低保真模型一样好或更好。 方法:将安乐死的猪置于体外循环上,创建一个可进行外科手术的灌注离体模型。研究参与者为普通外科二年级、三年级和四年级住院医师。住院医师被随机分配到猪实验室(PL)模拟器或干式实验室练习主动脉吻合术。PL组住院医师和对照组住院医师在橡胶管模型上进行首次血管吻合术。吻合过程被拍摄下来。吻合口和视频被保存以供后续评分。接下来,所有住院医师都与血管外科主治医生进行了一次无评分的一对一培训课程。培训课程结束后,所有住院医师完成了第二次录像的橡胶管吻合术。所使用的评分量表已得到其他作者的验证:整体评估得分、最终产品得分和清单评分工具。使用一份由13个问题组成的实验室前问卷和一份由16个问题组成的实验室后问卷收集描述该经历的调查数据,问卷包括是/否、多项选择和5点李克特量表问题。 结果:所有住院医师在有指导的练习后,完成时间和整体评估得分均有统计学意义的改善。PL组住院医师在第一次和第二次录像吻合术之间的完成时间有统计学意义的改善;然而,评分指标没有统计学意义的改善。对照组住院医师在所有三项评分指标上均有统计学意义的改善,但在完成时间上没有发现统计学意义的差异。调查数据显示,与兴趣无变化的对照组(P = 0.91)相比,PL组住院医师在经历该培训后,将血管外科作为职业的考虑有统计学意义的转变(P = 0.05)。 结论:我们的前瞻性随机临床试验表明,猪体外循环模型取得了与先前验证的台式模型相似的结果,同时提高了普通外科住院医师将血管外科作为职业的兴趣。
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