Wilson Erin B, Beckmann Michael M, Hewett David G, Jolly Brian C, Janssens Sarah
From Mater Research (E.B.W.), University of Queensland School of Medicine; Mothers Babies and Women's Health Services (M.M.B.), Mater Health Services, South Brisbane Mater Research (M.M.B.), Betty McGrath Research Fellow (M.M.B.), University of Queensland School of Medicine; University of Queensland School of Medicine (D.G.H.); Queen Elizabeth II Jubilee Hospital (D.G.H.), Brisbane, QLD, Australia; School of Medicine and Public Health (B.C.J.), University of Newcastle, Callaghan, New South Wales; Mater Health Services, South Brisbane (S.J.); and University of Queensland School of Medicine (S.J.), QLD, Australia.
Simul Healthc. 2017 Oct;12(5):304-307. doi: 10.1097/SIH.0000000000000242.
Large loop excision of the transformation zone (LLETZ) is a common gynecological treatment for cervical dysplasia but can be challenging to teach. There is no widely adopted simulator for this procedure in Australia, so a new low-fidelity simulator was designed and evaluated.
A simulator for a LLETZ procedure was developed. Doctors (N = 29), varied in experience level in gynecology at a tertiary hospital, performed a LLETZ procedure using the simulator. The procedures were filmed, and two independent assessors rated the deidentified videos. The assessment involved a checklist (of crucial procedural steps) and global rating scale to evaluate whether the simulator facilitated the demonstration of LLETZ procedure skills. Participants completed a questionnaire evaluating the performance and utility of the simulator to determine participant perceptions of simulator realism and acceptability.
The participant questionnaire revealed positive evaluations of realism and acceptability of the simulator. Performance scores were significantly different across experience levels (P < 0.001) with post hoc pairwise comparison between levels confirming significant differences between each group in assessed simulator performance for global rating scale and overall performance scores. The interrater reliability of the assessors was high (0.84).
A low-fidelity simulator for a LLETZ procedure seems to adequately demonstrate procedural performance reflecting doctor experience level. Participant questionnaire responses were positive, supporting further evaluation of the simulator for use in training.
转化区大环形切除术（LLETZ）是治疗宫颈发育异常的一种常见妇科治疗方法，但教授起来可能具有挑战性。在澳大利亚，目前尚无广泛采用的该手术模拟器，因此设计并评估了一种新型低保真模拟器。
开发了一种LLETZ手术模拟器。在一家三级医院，经验水平各异的29名医生使用该模拟器进行LLETZ手术。手术过程被拍摄下来，两名独立评估人员对匿名视频进行评分。评估包括一份（关键手术步骤的）检查表和整体评分量表，以评估模拟器是否有助于展示LLETZ手术技能。参与者完成一份问卷，评估模拟器的性能和实用性，以确定参与者对模拟器逼真度和可接受性的看法。
参与者问卷显示对模拟器的逼真度和可接受性评价积极。不同经验水平的表现得分存在显著差异（P < 0.001），事后各水平之间的两两比较证实，在整体评分量表和总体表现得分的评估模拟器性能方面，每组之间存在显著差异。评估人员之间的评分者信度较高（0.84）。
一种用于LLETZ手术的低保真模拟器似乎能充分展示反映医生经验水平的手术操作表现。参与者的问卷回复是积极的，支持对该模拟器在培训中的应用进行进一步评估。
