Belykh Evgenii, Miller Eric J, Lei Ting, Chapple Kristina, Byvaltsev Vadim A, Spetzler Robert F, Nakaji Peter, Preul Mark C
Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA; School of Life Sciences, Arizona State University, Tempe, Arizona, USA; Irkutsk State Medical University, Irkutsk, Russia.
University of Arizona College of Medicine-Phoenix, Phoenix, Arizona, USA.
World Neurosurg. 2017 Sep;105:952-960.e2. doi: 10.1016/j.wneu.2017.06.045. Epub 2017 Jun 21.
Proficient open surgical treatment of cerebral aneurysms requires extensive training and practice. This study tested the validity of a human placenta aneurysm model for surgical simulation training of aneurysm clipping.
There were 30 participants divided into 3 groups (n = 10 per group) according to their neurosurgical experience: low experience, intermediate experience, and attending. Subjective measures were collected using the Aneurysm Clipping Participant Survey (n = 27). Objective measures were collected by observing the participants (n = 30) work through a series of aneurysm clipping tasks while 2 independent raters evaluated them using a newly developed standardized tool, the Objective Structured Assessment of Aneurysm Clipping Skills.
In terms of the subjective measures of face validity, most of the attending group (7/10; 70%) rated the models as "somewhat" to "very well" replicating real surgery. Content validity assessment of the model showed that it could improve the following skills: microdissection technique (27/27; 100%), use of clip appliers for aneurysm clipping (27/27; 100%), and surgical technique when applied to patients (25/27; 93%). The objective measure for construct validity demonstrated that mean Objective Structured Assessment of Aneurysm Clipping Skills scores between the 3 groups (low-experience group, 22.9 ± 5.4; intermediate-experience group, 32.8 ± 4.0; attending group, 43.3 ± 1.3) differed significantly (P < 0.001).
The human placenta aneurysm clipping model is a useful training tool for teaching residents, with evidence of internal consistency and face, content, and construct validities. The Objective Structured Assessment of Aneurysm Clipping Skills scale is a feasible tool to assess aneurysm clipping skills quantitatively.
熟练进行脑动脉瘤开放手术治疗需要大量的培训和实践。本研究测试了人胎盘动脉瘤模型用于动脉瘤夹闭手术模拟训练的有效性。
根据神经外科经验将30名参与者分为3组（每组n = 10）：低经验组、中等经验组和主治医生组。使用动脉瘤夹闭参与者调查问卷收集主观指标（n = 27）。客观指标通过观察参与者（n = 30）完成一系列动脉瘤夹闭任务来收集，同时两名独立评估者使用新开发的标准化工具——动脉瘤夹闭技能客观结构化评估对他们进行评估。
在表面效度的主观指标方面，大多数主治医生组（7/10；70%）将模型评为“有点”到“非常好”地复制了真实手术。模型的内容效度评估表明，它可以提高以下技能：显微解剖技术（27/27；100%）、使用动脉瘤夹闭器夹闭动脉瘤（27/27；100%）以及应用于患者时的手术技术（25/27；93%）。结构效度的客观指标表明，3组之间的动脉瘤夹闭技能客观结构化评估平均得分（低经验组，22.9±5.4；中等经验组，32.8±4.0；主治医生组，——43.3±1.3）差异有统计学意义（P < 0.001）。
人胎盘动脉瘤夹闭模型是一种用于培训住院医师的有用工具，具有内部一致性以及表面效度、内容效度和结构效度的证据。动脉瘤夹闭技能客观结构化评估量表是一种定量评估动脉瘤夹闭技能的可行工具。
