Department of Otolaryngology-Head and Neck Surgery, University of Washington School of Medicine, Seattle, WA.
University of Washington School of Medicine, Seattle, WA.
Int Forum Allergy Rhinol. 2018 Apr;8(4):537-546. doi: 10.1002/alr.22069. Epub 2018 Jan 11.
Surgical skill development outside the operating room aims to improve technique and subsequent patient safety. The purpose of this study was to evaluate the correlation between technical and cognitive skills with cadaveric endoscopic sinus surgery (ESS) performance and change in ESS performance before and after implementation of a dedicated ESS simulation-based and knowledge-based curriculum.
A before-after study design was implemented among 10 medical students and 10 junior otolaryngology residents. Participants completed a knowledge-based, multiple-choice ESS pretest and watched an ESS prosection video. Participants performed 9 tasks on a previously validated low-cost, low-technology, nonbiologic sinus surgery task trainer followed by cadaveric maxillary antrostomy and anterior ethmoidectomy. Participants then completed a simulation-based and knowledge-based ESS curriculum followed by a repeat cadaveric maxillary antrostomy and anterior ethmoidectomy. Performance was graded with a 5-point global rating scale (GRS) and a 5-point ESS-specific checklist.
We observed a stronger correlation between the multiple-choice, knowledge-based, ESS pretest scores and cadaveric ESS GRS score (r = 0.73) than between task trainer performance and cadaveric ESS GRS score (r = 0.43). We also noted a significant increase in precurriculum vs postcurriculum mean ± standard deviation (SD) cadaveric ESS checklist scores for both medical students (1.18 ± 0.25 vs 2.58 ± 0.57; p = 0.0002) and residents (2.09 ± 0.78 vs 2.88 ± 0.54; p = 0.023). The greatest improvements for residents were in performance of uncinectomy, enlargement of maxillary os, and identification of the bulla.
These findings provide evidence supporting the use of ESS training curricula outside the operating room.
手术室外的外科技能发展旨在提高技术并提高患者安全性。本研究的目的是评估与尸体内镜鼻窦手术（ESS）表现相关的技术和认知技能，以及在实施专门的基于 ESS 模拟和基于知识的课程前后 ESS 表现的变化。
在 10 名医学生和 10 名初级耳鼻喉科住院医师中进行了前后研究设计。参与者完成了基于知识的 ESS 预测试多项选择题，并观看了 ESS 切开术视频。参与者在以前验证过的低成本、低技术、非生物鼻窦手术任务培训器上完成了 9 项任务，然后进行了尸体上颌窦切开术和前筛窦切除术。然后，参与者完成了基于模拟和基于知识的 ESS 课程，然后重复进行尸体上颌窦切开术和前筛窦切除术。表现通过 5 分制总体评分（GRS）和 5 分制 ESS 特定检查表进行评分。
我们观察到，多项选择题，基于知识的 ESS 预测试成绩与尸体 ESS GRS 评分之间的相关性更强（r = 0.73），而与任务培训器性能与尸体 ESS GRS 评分之间的相关性较弱（r = 0.43）。我们还注意到，在医学学生（1.18 ± 0.25 对 2.58 ± 0.57；p = 0.0002）和住院医师（2.09 ± 0.78 对 2.88 ± 0.54；p = 0.023）的术前课程与术后课程之间，尸体 ESS 检查表的平均得分（SD）都有显著增加。住院医师的最大改进是在执行钩突切除术，扩大上颌窦和识别泡方面。
这些发现为在手术室外使用 ESS 培训课程提供了证据。
