Segna E, Caruhel J-B, Corre P, Picard A, Biau D, Khonsari R H
Ospedale Maggiore Policlinico di Milano, Unità Operativa di Chirurgia Maxillo-facciale e Odontostomatologia, Università di Milano-Bicocca, Milan, Italy.
Assistance Publique - Hôpitaux de Paris, Service de Chirurgie Maxillofaciale, Hôpital Universitaire Pitié-Salpêtrière, Université Paris-Descartes, Paris, France.
Int J Oral Maxillofac Surg. 2018 Mar;47(3):366-373. doi: 10.1016/j.ijom.2017.10.005. Epub 2017 Oct 27.
The first step in cleft lip repair is the precise positioning of anatomical landmarks and tracing of the incisions on the patient's lip at the beginning of the procedure. The aim of this study was to evaluate progress made in learning cleft lip repair tracing using a quantitative assessment of learning curves: LC-CUSUM (learning curve - cumulative sum). Eight surgical residents were enrolled and asked to trace lip repair incisions on five cases of unilateral left cleft lip over 5 consecutive weeks. Results were compared to a reference tracing based on the positioning of nine anatomical landmarks and assessed using LC-CUSUM. Competence was defined as the accurate positioning of the nine landmarks (less than 1.4mm deviation from the reference positions, with an accepted 15% failure rate). After five tracing sessions, competence was not achieved evenly for all trainees, or for all landmarks, underlining differences in inter-individual learning ability even with similar training. However, despite an initial marked lack of theoretical and practical training in lip repair techniques, repeated drawings of cleft lip incisions allowed a satisfactory level of competence to be reached for most landmarks and most trainees. Nevertheless it was found that not all landmarks are understood by students with similar ease, and that landmark positioning reveals significant inter-individual differences. This approach allowed a global assessment of the teaching of cleft repair and will help to focus training on specific problematic points for which competence was not obtained according to the LC-CUSUM test.
唇裂修复的第一步是在手术开始时精确确定解剖标志的位置，并在患者唇部画出切口。本研究的目的是通过学习曲线的定量评估（学习曲线 - 累积和，即LC - CUSUM）来评估在学习唇裂修复画线方面取得的进展。招募了8名外科住院医师，要求他们在连续5周内对5例左侧单侧唇裂病例画出唇裂修复切口。将结果与基于9个解剖标志位置的参考画线进行比较，并使用LC - CUSUM进行评估。能力定义为9个标志的准确定位（与参考位置的偏差小于1.4毫米，允许15%的失败率）。经过5次画线练习后，并非所有学员对所有标志都能均匀地达到能力要求，这突出了个体间学习能力的差异，即使接受了相似的训练。然而，尽管最初在唇裂修复技术方面明显缺乏理论和实践培训，但重复画出唇裂切口使大多数标志和大多数学员达到了令人满意的能力水平。尽管如此，发现并非所有标志都能被学生同样轻松地理解，并且标志定位显示出显著的个体间差异。这种方法可以对唇裂修复教学进行全面评估，并有助于将培训重点放在根据LC - CUSUM测试未达到能力要求的特定问题点上。
