Bhatti Mominah, Ketheeswaran Ashradha, Arnold Amy, Nesbitt-Hawes Erin, Deans Rebecca, Won HaRyun, Abbott Jason
School of Women's and Children's Health, UNSW, Sydney, New South Wales, Australia.
Gynaecolgical Research and Clinical Evaluation (GRACE) Unit, Royal Hospital for Women, Sydney, New South Wales, Australia.
Aust N Z J Obstet Gynaecol. 2018 Apr;58(2):239-246. doi: 10.1111/ajo.12733. Epub 2017 Nov 23.
To investigate whether pelvic examination may be meaningfully taught to novice medical students and its accuracy in predicting operating times for laparoscopic excision of endometriosis at a single surgical procedure.
Women with suspected endometriosis scheduled for laparoscopy underwent pelvic examination to estimate operative time by medical students (novices), trainees, senior clinicians with <10 years surgical experience (experts) and ≥10 years (masters). Examination and intraoperative findings were compared and stage of disease recorded.
There were 138 estimations of operating time at the initial assessment and 251 estimations of operating time prior to surgery. The median surgical duration was 44 min (range 12-398) and increased progressively with revised American Society for Reproductive Medicine disease stage. Clinical predictions exceeded actual operating times by a median of 18 min (range overestimating by 180 min and underestimating by 120 min) with 80% of procedures completed in less time than predicted and none requiring a second procedure. There was no statistical difference in operative time estimations between the groups with students and trainees underestimating surgical duration by a median of two and five minutes, respectively, experts having a median time difference of zero minutes, and masters overestimating by 4.5 min.
Targeted pelvic examining may be taught to novices (medical students) and can be used to predict operating time at one surgical procedure. Less experienced examiners have a tendency to underestimate surgical duration, with masters overestimating surgical time when scheduling laparoscopies for endometriosis, and increasing disease stage is associated with a less precise estimation of surgical duration.
探讨是否可向医学新手学生有意义地教授盆腔检查，以及其在预测单次腹腔镜子宫内膜异位症切除术手术时间方面的准确性。
计划接受腹腔镜检查的疑似子宫内膜异位症女性患者接受盆腔检查，由医学学生（新手）、实习生、手术经验<10年的资深临床医生（专家）和≥10年的临床医生（大师）估计手术时间。比较检查结果与术中发现，并记录疾病分期。
初始评估时有138次手术时间估计，术前有251次手术时间估计。中位手术时长为44分钟（范围12 - 398分钟），且随着修订后的美国生殖医学学会疾病分期逐渐增加。临床预测超过实际手术时间的中位数为18分钟（范围高估180分钟，低估120分钟），80%的手术在比预测更短的时间内完成，且无一例需要二次手术。学生组和实习生组之间的手术时间估计无统计学差异，学生组和实习生组分别低估手术时长的中位数为2分钟和5分钟，专家组的中位数时间差异为0分钟，大师组高估4.5分钟。
可向新手（医学学生）教授有针对性的盆腔检查，且其可用于预测单次手术的手术时间。经验较少的检查者倾向于低估手术时长，而在安排子宫内膜异位症腹腔镜手术时，大师级检查者高估手术时间，且疾病分期增加与手术时长估计的精确性降低相关。
