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用于面部骨折评估与治疗的面部创伤模拟课程

A Facial Trauma Simulation Course for Evaluation and Treatment of Facial Fractures.

作者信息

Christophel J Jared, Park Stephen S, Nogan Stephen J, Essig Garth F

机构信息

Department of Otolaryngology-Head and Neck Surgery, University of Virginia School of Medicine, Charlottesville.

Department of Otolaryngology-Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus.

出版信息

JAMA Facial Plast Surg. 2017 Dec 1;19(6):464-467. doi: 10.1001/jamafacial.2017.0313.

Abstract

IMPORTANCE

Traditional facial trauma laboratories are used for teaching basic concepts of fracture reduction and hardware manipulation. Facial trauma simulation laboratories allow training physicians the opportunity to develop unique treatment plans as they would in real patient encounters.

OBJECTIVE

To assess the value of a novel facial trauma simulation course requiring residents to practice advanced decision making.

DESIGN, SETTING, AND PARTICIPANTS: Data were prospectively collected July 23 and August 23 and 24, 2016, in a survey study during a resident physician trauma simulation course. Fresh frozen cadaver heads were fractured using an impactor that applied a measurable amount of force. Each head was scanned with high-resolution computed tomography. Residents were paired and tasked with evaluating their specimen's imaging findings and developing a treatment plan.

MAIN OUTCOMES AND MEASURES

Before the course, residents were asked their postgraduate year level, number of facial fractures treated as a resident surgeon, and their comfort level based on the Otolaryngology Milestone for Facial Trauma (OMFT; ratings range from 0-5, with 5 indicating equivalent to fellow-level experience). After the course, residents were asked to assess the course's value relative to a theoretical number of actual operative cases, and a posttraining OMFT assessment was obtained.

RESULTS

Thirty resident physicians completed the course at 2 institutions. Residents represented an equivalent distribution of postgraduate year levels. The residents stated that the course was worth a mean (SD) of 6.4 (2.8) operative cases of facial trauma in terms of surgical learning. The mean change in self-reported OMFT rating after the course was 0.87 (95% CI, 0.67-1.07; P < .001, paired t test). On the basis of this change in self-perceived OMFT rating, the course was deemed to be worth 1.5 years of residency training in the management of facial fractures.

CONCLUSION AND RELEVANCE

Conducting a facial trauma simulation course increases resident experience with advanced surgical decision making.

LEVEL OF EVIDENCE

NA.

摘要

重要性

传统的面部创伤实验室用于教授骨折复位和硬件操作的基本概念。面部创伤模拟实验室使培训医师有机会制定独特的治疗方案,就如同他们在实际患者诊治中那样。

目的

评估一门要求住院医师进行高级决策制定练习的新型面部创伤模拟课程的价值。

设计、地点和参与者:于2016年7月23日以及8月23日和24日在一项住院医师创伤模拟课程期间的调查研究中前瞻性收集数据。使用施加可测量力的撞击器使新鲜冷冻的尸体头部骨折。每个头部均用高分辨率计算机断层扫描进行扫描。住院医师两两配对,负责评估其标本的影像学表现并制定治疗方案。

主要结局和测量指标

在课程开始前,询问住院医师的研究生年级、作为住院外科医生治疗的面部骨折数量,以及基于面部创伤的耳鼻喉科里程碑(OMFT;评分范围为0至5,5表示相当于同级别经验)的舒适程度。课程结束后,要求住院医师根据理论上的实际手术病例数量评估课程的价值,并获得培训后的OMFT评估结果。

结果

30名住院医师在2家机构完成了该课程。住院医师在研究生年级分布相当。住院医师表示,就手术学习而言,该课程平均(标准差)相当于6.4(2.8)例面部创伤手术病例。课程结束后自我报告的OMFT评分的平均变化为0.87(95%CI,0.67 - 1.07;P <.001,配对t检验)。基于自我感知的OMFT评分的这一变化,该课程被认为相当于1.5年的面部骨折管理住院医师培训。

结论及相关性

开展面部创伤模拟课程可增加住院医师进行高级手术决策的经验。

证据级别

无。

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