Calio Brian P, Kepler Christopher K, Koerner John D, Rihn Jeffrey A, Millhouse Paul, Radcliff Kris E
*Department of Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA †Rothman Institute, Philadelphia, PA.
Clin Spine Surg. 2017 Oct;30(8):E1126-E1129. doi: 10.1097/BSD.0000000000000211.
Cadaver training lab.
To determine if a technical cadaver skills training lab for spinal surgery increases resident confidence, satisfaction in training, and perception of operating room safety.
Resident training is an important topic in the setting of work hour reform. The use of supplemental materials such as videos, sawbones, and simulators may become important to adequately train orthopedic residents. At present, there are no established curricula for training orthopedic surgery residents on anatomy and common procedures encountered during a spinal surgery rotation.
Residents were assembled into teams of a PGY-5 and PGY-2 and/or PGY-1 to perform dissection and procedures on 5 fresh-frozen spine cadavers. With attending and spine fellow supervision, residents performed anterior cervical, posterior cervical, and posterior thoracolumbar surgical exposure, decompression, and fusion procedures in the operating room using surgical tools and instrumentation. Residents were then queried about their confidence levels, satisfaction in training, and perception of safety using a Likert scale (0-10). Strong agreement (scores ≥8) and strong disagreement (scores ≤3) and correlations were evaluated.
Seventeen residents completed the training program (7 PGY-1s, 2 PGY-2s, and 8 PGY-5s). After the training, the majority of residents strongly agreed that they had an increased confidence of their own abilities (59%). A significant majority (65%) of residents strongly agreed that they were satisfied with the benefits provided by the training program. Compared with other methods of education, residents strongly agreed that the training was more helpful than textbook chapters (94%), sawbones (94%), web-based training (94%), or a virtual-based (completely electronic) training (94%). After the training, residents strongly agreed that the training improved feelings of preparation (47%), safety (41%), and ability to prevent intraoperative errors (41%). The vast majority of residents strongly agreed "Before performing surgery on me, I would want a resident to perform this cadaveric training" (88%).
These results demonstrate that team-based, cadaveric training with adequate attending supervision, before onset of a spine surgical rotation, may lead to high resident confidence, satisfaction in training, and perception of patient safety.
尸体训练实验室。
确定一个脊柱外科技术尸体技能训练实验室是否能提高住院医师的信心、培训满意度以及对手术室安全性的认知。
在工作时间改革背景下，住院医师培训是一个重要课题。使用视频、模型和模拟器等辅助材料对于充分培训骨科住院医师可能变得很重要。目前，尚无针对骨科手术住院医师进行脊柱手术轮转期间所涉及的解剖学和常见手术的既定课程。
将住院医师分成由一名PGY - 5和一名PGY - 2及/或PGY - 1组成的小组，对5具新鲜冷冻脊柱尸体进行解剖和手术操作。在主治医生和脊柱专科住院医师的监督下，住院医师在手术室使用手术工具和器械进行颈椎前路、颈椎后路以及胸腰椎后路的手术暴露、减压和融合手术。然后使用李克特量表（0 - 10）询问住院医师关于他们的信心水平、培训满意度以及对安全性的认知。评估强烈同意（得分≥8）和强烈不同意（得分≤3）以及相关性。
17名住院医师完成了培训项目（7名PGY - 1、2名PGY - 2和8名PGY - 5）。培训后，大多数住院医师强烈同意他们对自身能力的信心有所增强（59%）。绝大多数（65%）住院医师强烈同意他们对培训项目提供的益处感到满意。与其他教育方法相比，住院医师强烈同意该培训比教科书章节（94%）、模型（94%）、网络培训（94%）或虚拟（完全电子化）培训（94%）更有帮助。培训后，住院医师强烈同意该培训提高了准备感（47%）、安全感（41%）以及预防术中错误的能力（41%）。绝大多数住院医师强烈同意“在给我做手术之前，我希望住院医师先进行这种尸体训练”（88%）。
这些结果表明，在脊柱外科轮转开始前，在主治医生充分监督下进行基于团队的尸体训练，可能会使住院医师获得较高的信心、培训满意度以及对患者安全的认知。
