Freeman Lynetta J, Ferguson Nancy, Fellenstein Carol, Johnson Ron, Constable Peter D
J Am Vet Med Assoc. 2017 Aug 1;251(3):322-332. doi: 10.2460/javma.251.3.322.
OBJECTIVE To define learning curves for fourth-year veterinary students performing ovariohysterectomy procedures in dogs and cats and castration in dogs. DESIGN Retrospective study. SAMPLE 3,196 ovariohysterectomies or castrations performed in dogs and cats by 88 veterinary students during a spay-neuter surgery and animal shelter rotation (n = 3,056) or by 1 experienced general practitioner (n = 140). PROCEDURES Data collected from medical records included patient signalment, type and duration of procedure, and sequence (by date and time) of the procedure within a list of procedures of the same type generated for each student. For each procedure type, geometric mean surgery time and 95% confidence intervals were determined for each number of surgeries completed by ≥ 10 students. Median surgery times for the same procedure types were determined for the experienced practitioner. The learning curve for each procedure was modeled with nonlinear (3-factor exponential equation with a nonzero asymptote) and linear regression. For each procedure, the asymptote (optimal surgery time) for students was compared with the experienced practitioner's median surgery time. RESULTS 2,945 surgeries (mean, 33/student) performed by ≥ 10 students were analyzed. Surgery time decreased in a nonlinear manner as student experience increased for castration of adult or pediatric dogs and ovariohysterectomy of pediatric dogs and adult or pediatric cats. Surgery time decreased in a linear manner as experience increased for ovariohysterectomy of adult dogs. CONCLUSIONS AND CLINICAL RELEVANCE To the authors' knowledge, this was the first study to map surgery times for common surgical procedures consecutively performed by veterinary students. Results clearly indicated the value of repetition to improve surgical skills (as measured by surgery time) during a 3-week period.
目的 确定四年级兽医专业学生对犬猫进行卵巢子宫切除术以及对犬进行去势手术的学习曲线。 设计 回顾性研究。 样本 88 名兽医专业学生在绝育手术和动物收容所轮转期间对犬猫进行的 3196 例卵巢子宫切除术或去势手术（n = 3056），以及 1 名经验丰富的全科医生进行的 140 例手术。 程序 从病历中收集的数据包括患者特征、手术类型和持续时间，以及在为每个学生生成的同类型手术列表中该手术的顺序（按日期和时间）。对于每种手术类型，确定了≥10 名学生完成的每种手术数量对应的几何平均手术时间和 95%置信区间。确定了经验丰富的从业者相同手术类型的中位手术时间。每种手术的学习曲线采用非线性（具有非零渐近线的三因素指数方程）和线性回归进行建模。对于每种手术，将学生的渐近线（最佳手术时间）与经验丰富的从业者的中位手术时间进行比较。 结果 分析了≥10 名学生进行的 2945 例手术（平均每名学生 33 例）。随着学生经验的增加，成年或幼年犬去势、幼年犬卵巢子宫切除术以及成年或幼年猫卵巢子宫切除术的手术时间呈非线性下降。成年犬卵巢子宫切除术的手术时间随着经验的增加呈线性下降。 结论及临床意义 据作者所知，这是第一项绘制兽医专业学生连续进行的常见外科手术手术时间的研究。结果清楚地表明了在 3 周时间内重复练习对提高手术技能（以手术时间衡量）的价值。
