Weber Erin L, Leland Hyuma A, Azadgoli Beina, Minneti Michael, Carey Joseph N
Division of Plastic and Reconstructive Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California, USA.
Ann Transl Med. 2017 Aug;5(15):302. doi: 10.21037/atm.2017.06.28.
Rehearsal is an essential part of mastering any technical skill. The efficacy of surgical rehearsal is currently limited by low fidelity simulation models. Fresh cadaver models, however, offer maximal surgical simulation. We hypothesize that preoperative surgical rehearsal using fresh tissue surgical simulation will improve resident confidence and serve as an important adjunct to current training methods.
Preoperative rehearsal of surgical procedures was performed by plastic surgery residents using fresh cadavers in a simulated operative environment. Rehearsal was designed to mimic the clinical operation, complete with a surgical technician to assist. A retrospective, web-based survey was used to assess resident perception of pre- and post-procedure confidence, preparation, technique, speed, safety, and anatomical knowledge on a 5-point scale (1= not confident, 5= very confident).
Twenty-six rehearsals were performed by 9 residents (PGY 1-7) an average of 4.7±2.1 days prior to performance of the scheduled operation. Surveys demonstrated a median pre-simulation confidence score of 2 and a post-rehearsal score of 4 (P<0.01). The perceived improvement in confidence and performance was greatest when simulation was performed within 3 days of the scheduled case. All residents felt that cadaveric simulation was better than standard preparation methods of self-directed reading or discussion with other surgeons. All residents believed that their technique, speed, safety, and anatomical knowledge improved as a result of simulation.
Fresh tissue-based preoperative surgical rehearsal was effectively implemented in the residency program. Resident confidence and perception of technique improved. Survey results suggest that cadaveric simulation is beneficial for all levels of residents. We believe that implementation of preoperative surgical rehearsal is an effective adjunct to surgical training at all skill levels in the current environment of decreased work hours.
演练是掌握任何技术技能的重要组成部分。目前，手术演练的效果受到低保真模拟模型的限制。然而，新鲜尸体模型可提供最高程度的手术模拟。我们假设，使用新鲜组织手术模拟进行术前手术演练将提高住院医师的信心，并成为当前培训方法的重要辅助手段。
整形外科住院医师在模拟手术环境中使用新鲜尸体进行手术操作的术前演练。演练旨在模拟临床手术，并有手术技师协助。通过一项基于网络的回顾性调查，以5分制（1= 不自信，5= 非常自信）评估住院医师对术前和术后信心、准备情况、技术、速度、安全性及解剖知识的看法。
9名住院医师（PGY 1 - 7）共进行了26次演练，平均在预定手术前4.7±2.1天进行。调查显示，模拟前信心评分中位数为2分，演练后为4分（P<0.01）。当在预定手术前3天内进行模拟时，信心和表现的感知改善最为明显。所有住院医师都认为尸体模拟优于自我指导阅读或与其他外科医生讨论等标准准备方法。所有住院医师都认为，模拟使他们的技术、速度、安全性及解剖知识得到了提高。
在住院医师培训项目中有效实施了基于新鲜组织的术前手术演练。住院医师的信心和对技术的认知得到了改善。调查结果表明，尸体模拟对各级住院医师都有益。我们认为，在当前工作时间减少的环境下，实施术前手术演练是各级手术技能培训的有效辅助手段。
