Maertens H, Aggarwal R, Moreels N, Vermassen F, Van Herzeele I
Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
Department of Surgery, Faculty of Medicine, McGill University, Montreal, Canada; Steinberg Centre for Simulation and Interactive Learning, Faculty of Medicine, McGill University, Montreal, Canada.
Eur J Vasc Endovasc Surg. 2017 Sep;54(3):387-396. doi: 10.1016/j.ejvs.2017.06.011. Epub 2017 Jul 19.
Healthcare evolution requires optimisation of surgical training to provide safe patient care. Operating room performance after completion of proficiency based training in vascular surgery has not been investigated.
A randomised controlled trial evaluated the impact of a Proficiency based Stepwise Endovascular Curricular Training program (PROSPECT) on the acquisition of endovascular skills and the transferability of these skills to real life interventions.
All subjects performed two endovascular interventions treating patients with symptomatic iliac and/or superficial femoral artery stenosis under supervision. Primary outcomes were technical performances (Global Rating Scale [GRS]; Examiner Checklist), operative metrics, and patient outcomes, adjusted for case difficulty and trainee experience. Secondary outcomes included knowledge and technical performance after 6 weeks and 3 months.
Thirty-two general surgical trainees were randomised into three groups. Besides traditional training, the first group (n = 11) received e-learning and simulation training (PROSPECT), the second group (n = 10) only had access to e-learning, while controls (n = 11) did not receive supplementary training.
Twenty-nine trainees (3 dropouts) performed 58 procedures. Trainees who completed PROSPECT showed superior technical performance (GRS 39.36 ± 2.05; Checklist 63.51 ± 3.18) in real life with significantly fewer supervisor takeovers compared with trainees receiving e-learning alone (GRS 28.42 ± 2.15; p = .001; Checklist 53.63 ± 3.34; p = .027) or traditional education (GRS 23.09 ± 2.18; p = .001; Checklist 38.72 ± 3.38; p = .001). Supervisors felt more confident in allowing PROSPECT trained physicians to perform basic (p = .006) and complex (p = .003) procedures. No differences were detected in procedural parameters (such as fluoroscopy time, DAP, procedure time, etc.) or complications. Proficiency levels were maintained up to 3 months.
A structured, stepwise, proficiency based endovascular curriculum including e-learning and simulation based training should be integrated early into training programs to enhance trainee performance.
医疗保健的发展需要优化外科培训，以提供安全的患者护理。基于熟练程度的血管外科培训完成后的手术室表现尚未得到研究。
一项随机对照试验评估了基于熟练程度的逐步血管内课程培训计划（PROSPECT）对血管内技能获取以及这些技能向现实生活干预的可转移性的影响。
所有受试者在监督下对有症状的髂动脉和/或股浅动脉狭窄患者进行了两次血管内干预。主要结局是技术表现（全球评级量表[GRS]；考官检查表）、手术指标和患者结局，并根据病例难度和受训者经验进行调整。次要结局包括6周和3个月后的知识和技术表现。
32名普通外科受训者被随机分为三组。除传统培训外，第一组（n = 11）接受电子学习和模拟培训（PROSPECT），第二组（n = 10）只能访问电子学习，而对照组（n = 11）未接受补充培训。
29名受训者（3名退出者）进行了58例手术。完成PROSPECT的受训者在现实生活中表现出更高的技术表现（GRS 39.36 ± 2.05；检查表63.51 ± 3.18），与仅接受电子学习的受训者（GRS 28.42 ± 2.15；p = 0.001；检查表53.63 ± 3.34；p = 0.027）或传统教育的受训者（GRS 23.09 ± 2.18；p = 0.001；检查表38.72 ± 3.38；p = 0.001）相比，主管接管显著减少。主管对允许接受PROSPECT培训的医生进行基本（p = 0.006）和复杂（p = 0.003）手术更有信心。在手术参数（如透视时间、剂量面积乘积、手术时间等）或并发症方面未发现差异。熟练水平维持了3个月。
应将包括电子学习和模拟培训在内的结构化、逐步、基于熟练程度的血管内课程尽早纳入培训计划，以提高受训者的表现。
