Romero Philipp, Günther Patrick, Kowalewski Karl-Friedrich, Friedrich Mirco, Schmidt Mona W, Trent Sarah M, De La Garza Javier R, Müller-Stich Beat P, Nickel Felix
Department of Pediatric Surgery, University of Heidelberg, Heidelberg, Germany.
Department of General, Visceral, and Transplantation Surgery, University of Heidelberg Heidelberg, Germany.
J Surg Educ. 2018 Mar-Apr;75(2):510-515. doi: 10.1016/j.jsurg.2017.07.025. Epub 2017 Aug 8.
This study aimed to compare the effectiveness of Halsted's method "see one, do one, and teach one" with Peyton's Four-Step Approach for teaching intracorporal suturing and knot tying (ICKT).
Laparoscopically naïve medical students (n = 60) were randomized to teaching of ICKT with either Halsted's (n = 30) or Peyton's method (n = 30) for 60 minutes. Each student's first 3 and final sutures were evaluated using Objective Structured Assessment of Technical Skills (OSATS), procedural implementation, knot quality, total time, and suture placement accuracy.
Performance score and OSATS-PSC always differed significantly in favor of Peyton's group (p = 0.001). OSATS-GRS (p = 0.01) and task time (p = 0.03) differed only in the summary of the first 3 sutures in favor of Peyton's group. There were no significant intergroup differences in knot quality and accuracy.
Peyton's Four-Step Approach is the preferable method for learning complex laparoscopic skills like ICKT.
本研究旨在比较霍尔斯特德“看一个，做一个，教一个”方法与佩顿四步法在体内缝合和打结教学中的有效性。
将初次接触腹腔镜手术的医学生（n = 60）随机分为两组，分别采用霍尔斯特德方法（n = 30）或佩顿方法（n = 30）进行60分钟的体内缝合和打结教学。使用客观结构化技术技能评估（OSATS）、操作实施、打结质量、总时间和缝合位置准确性对每位学生的前3针和最后一针进行评估。
佩顿组的表现得分和OSATS-PSC始终显著更高（p = 0.001）。仅在前3针缝合的总结中，OSATS-GRS（p = 0.01）和任务时间（p = 0.03）在佩顿组更具优势。两组在打结质量和准确性方面无显著差异。
佩顿四步法是学习如体内缝合和打结等复杂腹腔镜技能的更优方法。
