Kaban Leonard B, Cappetta Alyssa, George Brian C, Lahey Edward T, Bohnen Jordan D, Troulis Maria J
Walter C. Guralnick Distinguished Professor and Chief Emeritus, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine and Harvard Medical School, Boston, MA.
Student Research Associate, Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, Harvard School of Dental Medicine and Harvard Medical School, Boston, MA.
J Oral Maxillofac Surg. 2017 Oct;75(10):2041-2047. doi: 10.1016/j.joms.2017.05.036. Epub 2017 Jun 8.
There are no universally accepted tools to evaluate operative skills of surgical residents in a timely fashion. The purpose of this study was to determine the feasibility of using a smartphone application, SIMPL (System for Improving and Measuring Procedural Learning), developed by a multi-institutional research collaborative, to achieve a high rate of timely operative evaluations and resident communication and to collect performance data. The authors hypothesized that these goals would be achieved because the process is convenient and efficient.
This was a prospective feasibility and engagement study using SIMPL to evaluate residents' operative skills. SIMPL requires the attending surgeon to answer 3 multiple-choice questions: 1) What level of help (Zwisch Scale) was required by the trainee? 2) What was the level of performance? 3) How complex was the case? The evaluator also can dictate a narrative. The sample was composed of 3 faculty members and 3 volunteer senior residents. Predictor variables were the surgeons, trainees, and procedures performed. Outcome variables included number and percentage of procedures performed by faculty-and-resident pairs assessed, time required to complete assessments, time lapsed to submission, percentage of assessments with narratives, and residents' response rates.
From March through June 2016, 151 procedures were performed in the operating room by the faculty-and-resident teams. There were 107 assessments submitted (71%). Resident response (self-assessment) to faculty evaluations was 81%. Recorded time to complete assessments (n = 75 of 107) was shorter than 2 minutes. The time lapsed to submission was shorter than 72 hours (100%). Dictations were submitted for 35 evaluations (33%). Data for the type of help, performance, and complexity of cases were collected for each resident.
SIMPL facilitates timely intraoperative evaluations of surgical skills, engagement by faculty and residents, and collection of detailed procedural data. Additional prospective trials to assess this tool further are planned.
目前尚无被广泛接受的工具能及时评估外科住院医师的手术技能。本研究的目的是确定使用一款由多机构研究协作开发的智能手机应用程序SIMPL（改善和测量程序学习系统）来实现高比例的及时手术评估、住院医师沟通以及收集绩效数据的可行性。作者推测这些目标能够实现，因为该流程便捷高效。
这是一项使用SIMPL评估住院医师手术技能的前瞻性可行性和参与度研究。SIMPL要求主刀医生回答3个多项选择题：1）实习生需要何种程度的帮助（Zwisch量表）？2）表现水平如何？3）病例的复杂程度如何？评估者还可以口述一段叙述。样本由3名教员和3名志愿高级住院医师组成。预测变量为外科医生、实习生以及所实施的手术。结果变量包括教员-住院医师对完成评估的手术数量和百分比、完成评估所需时间、提交延迟时间、有叙述的评估百分比以及住院医师的回复率。
2016年3月至6月期间，教员-住院医师团队在手术室进行了151例手术。共提交了107份评估（71%）。住院医师对教员评估的回复（自我评估）率为81%。记录的完成评估时间（107份中的75份）短于2分钟。提交延迟时间短于72小时（100%）。35份评估（33%）提交了口述内容。收集了每位住院医师关于帮助类型、表现以及病例复杂程度的数据。
SIMPL有助于及时进行手术技能的术中评估、教员和住院医师的参与以及详细手术数据的收集。计划开展进一步评估该工具的额外前瞻性试验。
