Manuel-Palazuelos Jose Carlos, Riaño-Molleda María, Ruiz-Gómez José Luis, Martín-Parra Jose Ignacio, Redondo-Figuero Carlos, Maestre José María
Hospital Virtual Valdecilla, Avda. de Valdecilla s/n, 39008 Santander, Spain.
Adv Simul (Lond). 2016 May 25;1:16. doi: 10.1186/s41077-016-0017-y. eCollection 2016.
The identification of developmental curve patterns generated by a simulation-based educational method and the variables that can accelerate the learning process will result in cost-effective training. This study describes the learning curves of a simulation-based instructional design (ID) that uses ex vivo animal models to teach laparoscopic latero-lateral small bowel anastomosis.
Twenty general surgery residents were evaluated on their performance of laparoscopic latero-lateral jejuno-jejunal anastomoses (JJA) and gastro-jejunal anastomoses (GJA), using swine small bowel and stomach on an endotrainer. The ID included the following steps: (1) provision of references and videos demonstrating the surgical technique, (2) creation of an engaging context for learning, (3) critical review of the literature and video on the procedures, (4) demonstration of the critical steps, (5) hands-on practice, (6) in-action instructor's feedback, (7) quality assessment, (8) debriefing at the end of the session, and (9) deliberate and repetitive practice. Time was recorded from the beginning to the completion of the procedure, along with the presence or absence of anastomotic leaks.
The participants needed to perform 23.8 ± 6.96 GJA (12-35) and 24.2 ± 6.96 JJA (9-43) to attain proficiency. The starting point of the learning curve was higher for the GJA than for the JJA, although the slope and plateau were parallel. Further, four types of learning curves were identified: (1) exponential, (2) rapid, (3) slow, and (4) no tendency. The type of pattern could be predicted after procedure number 8.
These findings may help to identify the learning curve of a trainee early in the developmental process, estimate the number of sessions required to reach a performance goal, determine a trainee's readiness to practice the procedure on patients, and identify the subjects who lack the innate technical abilities. It may help motivated individuals to become reflective and self-regulated learners. Moreover, the standardization of the ID may help to measure the effectiveness of learning strategies and make comparisons with other educational strategies.
识别基于模拟的教育方法所产生的发展曲线模式以及能够加速学习过程的变量，将带来具有成本效益的培训。本研究描述了一种基于模拟的教学设计（ID）的学习曲线，该设计使用离体动物模型教授腹腔镜侧侧小肠吻合术。
使用猪的小肠和胃在内置训练器上，对20名普通外科住院医师进行腹腔镜侧侧空肠空肠吻合术（JJA）和胃空肠吻合术（GJA）操作评估。该教学设计包括以下步骤：（1）提供展示手术技术的参考文献和视频；（2）创建引人入胜的学习情境；（3）对文献和手术视频进行批判性回顾；（4）演示关键步骤；（5）实践操作；（6）实操过程中指导教师的反馈；（7）质量评估；（8）课程结束时的总结汇报；（9）刻意且重复的练习。记录从开始到完成手术的时间，以及有无吻合口漏。
参与者需要进行23.8±6.96次GJA（12 - 35次）和24.2±6.96次JJA（9 - 43次）才能达到熟练水平。GJA学习曲线的起点高于JJA，尽管斜率和平原是平行的。此外，识别出四种类型的学习曲线：（1）指数型；（2）快速型；（3）缓慢型；（4）无趋势型。在第8次手术后可以预测模式类型。
这些发现可能有助于在发展过程早期识别学员的学习曲线，估计达到操作目标所需的课程数量，确定学员对在患者身上进行该操作的准备情况，并识别缺乏先天技术能力的受试者。它可能有助于有积极性的个体成为反思性和自我调节性的学习者。此外，教学设计的标准化可能有助于衡量学习策略的有效性，并与其他教育策略进行比较。
