Bunogerane Gisele Juru, Taylor Kathryn, Lin Yihan, Costas-Chavarri Ainhoa
Department of General Surgery, College of Medicine and Health Sciences, University of Rwanda, Kigali, Republic of Rwanda.
Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
J Surg Educ. 2018 Jan-Feb;75(1):231-237. doi: 10.1016/j.jsurg.2017.06.016. Epub 2017 Jul 13.
BACKGROUND/OBJECTIVE: There is a severe surgical workforce shortage in Rwanda. Innovative educational tools must be introduced to train more residents and increase surgical capacity. Touch Surgery (TS) is a smartphone application that offers trainees the opportunity to practice operations; however, its effect is unknown in low- and middle-income countries. Our objectives were to determine the training effect of TS and its feasibility for use in surgery education in a low-resource setting.
We performed a randomized control trial of University of Rwanda surgical residents. Participants were blocked by postgraduate year and randomized to textbook or TS for learning tendon repair surgical technique. After the learning period, participants performed a tendon repair simulation, evaluated by blinded expert raters. Presimulation and postsimulation questionnaires tested their knowledge of tendon repair.
The study was conducted at the simulation center of the University Teaching Hospital of Kigali, a tertiary referral and teaching hospital.
The study included University of Rwanda surgery residents. A total 27 of 51 surgery residents (52.94%) were enrolled. Participating residents represented the following specialties: general surgery (51.85%), orthopedics (40.74%), and urology (7.41%).
TS users scored 89.7% on tendon repair simulation, compared to textbook users who scored 63.4% (p < 0.001). Postsimulation questionnaires showed a significant improvement in cognitive scores for TS users (38.6%, p < 0.001), as compared to nonsignificant improvement for textbook users (15.9%, p = 0.304). About 92.3% of TS users reported that TS represents a useful training tool, and 61.5% reported that it would be a good or very good required part of the curriculum.
TS is a useful tool to improve both technical skills and knowledge of tendon repair procedure steps; however, its role may be limited to a supplemental tool as it does not improve the theoretical knowledge. TS has the potential to be implemented in a surgical academic curriculum in low- and middle-income countries.
背景/目的：卢旺达存在严重的外科手术人员短缺问题。必须引入创新的教育工具来培训更多住院医师并提高手术能力。触摸手术（TS）是一款智能手机应用程序，为学员提供了练习手术的机会；然而，其在低收入和中等收入国家的效果尚不清楚。我们的目标是确定TS的培训效果及其在资源匮乏环境中用于外科手术教育的可行性。
我们对卢旺达大学的外科住院医师进行了一项随机对照试验。参与者按研究生年级进行分组，并随机分为使用教科书组或TS组来学习肌腱修复手术技术。学习期结束后，参与者进行肌腱修复模拟操作，由不知情的专家评分员进行评估。模拟操作前和模拟操作后的问卷测试了他们对肌腱修复的知识。
该研究在基加利大学教学医院的模拟中心进行，该医院是一家三级转诊和教学医院。
该研究纳入了卢旺达大学的外科住院医师。51名外科住院医师中共有27名（52.94%）参与。参与的住院医师代表以下专业：普通外科（51.85%）、骨科（40.74%）和泌尿外科（7.41%）。
TS用户在肌腱修复模拟操作中的得分为89.7%，而使用教科书的用户得分为63.4%（p < 0.001）。模拟操作后的问卷显示，TS用户的认知得分有显著提高（38.6%，p < 0.001），而使用教科书的用户得分提高不显著（15.9%，p = 0.304）。约92.3%的TS用户表示TS是一种有用的培训工具，61.5%的用户表示它将是课程中很好或非常好的必修部分。
TS是提高肌腱修复手术技术技能和程序步骤知识的有用工具；然而，其作用可能仅限于辅助工具，因为它并不能提高理论知识。TS有潜力在低收入和中等收入国家的外科医学课程中实施。
