Anand Mallika, Duffy Conor P, Vragovic Olivera, Abbasi Wafaa, Bell Shannon L
Female Pelvic Med Reconstr Surg. 2018 Mar/Apr;24(2):176-182. doi: 10.1097/SPV.0000000000000545.
Obstetrics and gynecology residents are less prepared to perform vaginal hysterectomy (VH), despite its advantages over other hysterectomy routes. The American Congress of Obstetricians and Gynecologists and Council on Resident Education in Obstetrics and Gynecology have prioritized simulation training in VH. Our objective was to improve residents' understanding of surgical anatomy of VH using a resident-constructed, low-cost, low-fidelity model.
A single simulation session was held in November 2016. Residents constructed a pelvic model, guided by 2 surgeons. A pretest and a posttest were administered. Experienced-based responses were tabulated for frequencies and contents. Improvement on knowledge-based questions was assessed using McNemar's test.
Of 20 residents, 16 completed the pretest and 14 (70%) completed pretests and posttests. One hundred percent of postgraduate year (PGY)-4 had performed greater than 10 VH (11-21) and 75% of PGY-3 had performed 5 to 12 VH. Although 75% of PGY-3 and 100% of PGY-4 felt comfortable performing VH, baseline knowledge of essential surgical anatomy of VH was low (65.8%). The PGY-3 and -4 group (n=8) experienced a mean improvement of 24.4% (mean pretest score 65.8% vs mean posttest score 90%; 95% confidence interval, +14.1% to +33.3%, P=0.0005). The PGY-1 and -2 groups (n=6) experienced a mean improvement of 43.3% (mean pretest score, 41.7% vs mean posttest score, 85%; 95% confidence interval, +26.7% to +59.2%, P=0.001). After the session, all residents reported improved understanding surgical anatomy of VH and "more hands-on sessions" was the most frequently requested teaching aid.
Residents desire additional model-based simulation training in VH, and such structured, model-based simulations can identify and address gaps in resident knowledge of surgical anatomy of this important operation.
尽管阴式子宫切除术（VH）相较于其他子宫切除途径具有优势，但妇产科住院医师对其操作的准备仍不足。美国妇产科医师大会和妇产科住院医师教育委员会已将VH模拟培训列为优先事项。我们的目标是使用住院医师自制的低成本、低保真模型，提高住院医师对VH手术解剖结构的理解。
2016年11月举行了一次模拟培训课程。住院医师在2名外科医生的指导下制作盆腔模型。进行了一次预测试和一次后测试。对基于经验的回答的频率和内容进行了列表统计。使用McNemar检验评估基于知识的问题的改善情况。
20名住院医师中，16名完成了预测试，14名（70%）完成了预测试和后测试。四年级住院医师（PGY-4）中100%进行过超过10例VH手术（11 - 21例），三年级住院医师（PGY-3）中75%进行过5至12例VH手术。尽管75%的PGY-3和100%的PGY-4在进行VH手术时感觉得心应手，但VH基本手术解剖结构的基线知识水平较低（65.8%）。PGY-3和PGY-4组（n = 8）平均提高了24.4%（预测试平均得分65.8%，后测试平均得分90%；95%置信区间，+14.1%至+33.3%，P = 0.0005）。PGY-1和PGY-2组（n = 6）平均提高了43.3%（预测试平均得分41.7%，后测试平均得分85%；95%置信区间，+26.7%至+59.2%，P = 0.001）。培训课程结束后，所有住院医师均表示对VH手术解剖结构的理解有所提高，“更多实践课程”是最常被要求的教学辅助方式。
住院医师希望获得更多关于VH的基于模型的模拟培训，这种结构化的、基于模型的模拟可以识别并弥补住院医师在这一重要手术的手术解剖知识方面的差距。
