Beth Israel Deaconess Medical Center, Boston, MA, USA.
Baylor University Medical Center at Dallas, Dallas, TX, USA.
Surg Endosc. 2018 Apr;32(4):1990-2002. doi: 10.1007/s00464-017-5895-0. Epub 2017 Oct 19.
Mastery of laparoscopic skills is essential in surgical practice and requires considerable time and effort to achieve. The Virtual Basic Laparoscopic Skill Trainer (VBLaST-PC) is a virtual simulator that was developed as a computerized version of the pattern cutting (PC) task in the Fundamentals of Laparoscopic Surgery (FLS) system. To establish convergent validity for the VBLaST-PC, we assessed trainees' learning curves using the cumulative summation (CUSUM) method and compared them with those on the FLS.
Twenty-four medical students were randomly assigned to an FLS training group, a VBLaST training group, or a control group. Fifteen training sessions, 30 min in duration per session per day, were conducted over 3 weeks. All subjects completed pretest, posttest, and retention test (2 weeks after posttest) on both the FLS and VBLaST simulators. Performance data, including time, error, FLS score, learning rate, learning plateau, and CUSUM score, were analyzed.
The learning curve for all trained subjects demonstrated increasing performance and a performance plateau. CUSUM analyses showed that five of the seven subjects reached the intermediate proficiency level but none reached the expert proficiency level after 150 practice trials. Performance was significantly improved after simulation training, but only in the assigned simulator. No significant decay of skills after 2 weeks of disuse was observed. Control subjects did not show any learning on the FLS simulator, but improved continually in the VBLaST simulator.
Although VBLaST- and FLS-trained subjects demonstrated similar learning rates and plateaus, the majority of subjects required more than 150 trials to achieve proficiency. Trained subjects demonstrated improved performance in only the assigned simulator, indicating specificity of training. The virtual simulator may provide better opportunities for learning, especially with limited training exposure.
掌握腹腔镜技能对于外科实践至关重要，需要大量的时间和努力才能实现。Virtual Basic Laparoscopic Skill Trainer (VBLaST-PC) 是一种虚拟模拟器，是 Fundamentals of Laparoscopic Surgery (FLS) 系统中模式切割 (PC) 任务的计算机化版本。为了建立 VBLaST-PC 的收敛有效性，我们使用累积和 (CUSUM) 方法评估学员的学习曲线，并将其与 FLS 的学习曲线进行比较。
24 名医学生被随机分配到 FLS 培训组、VBLaST 培训组或对照组。在 3 周内，每天进行 30 分钟的 15 次培训课程。所有受试者均在 FLS 和 VBLaST 模拟器上完成预测试、后测试和保留测试（后测试后 2 周）。分析了性能数据，包括时间、错误、FLS 分数、学习率、学习平台和 CUSUM 分数。
所有接受培训的受试者的学习曲线均表现出性能的提高和平台的出现。CUSUM 分析显示，在 150 次练习后，有 5 名受试者达到了中级熟练水平，但没有一名达到专家熟练水平。模拟训练后，性能明显提高，但仅在分配的模拟器中。在 2 周的不用后，没有观察到技能明显下降。对照组在 FLS 模拟器上没有表现出任何学习，但在 VBLaST 模拟器上不断提高。
尽管 VBLaST 和 FLS 训练的受试者表现出相似的学习率和平台，但大多数受试者需要超过 150 次试验才能达到熟练水平。训练有素的受试者仅在分配的模拟器中表现出更好的性能，表明培训的特异性。虚拟模拟器可能提供更好的学习机会，特别是在有限的培训暴露下。
