卢旺达普通胸外科模拟课程的创建、实施和评估。
Creation, Implementation, and Assessment of a General Thoracic Surgery Simulation Course in Rwanda.
机构信息
Department of Surgery, University of Virginia, Charlottesville, Virginia.
School of Medicine, University of Virginia, Charlottesville, Virginia.
出版信息
Ann Thorac Surg. 2018 Jun;105(6):1842-1849. doi: 10.1016/j.athoracsur.2018.01.043. Epub 2018 Feb 21.
BACKGROUND
The primary objective was to provide proof of concept of conducting thoracic surgical simulation in a low-middle income country. Secondary objectives were to accelerate general thoracic surgery skills acquisition by general surgery residents and sustain simulation surgery teaching through a website, simulation models, and teaching of local faculty.
METHODS
Five training models were created for use in a low-middle income country setting and implemented during on-site courses with Rwandan general surgery residents. A website http://thoracicsurgeryeducation.com was created as a supplement to the on-site teaching. All participants completed a course knowledge assessment before and after the simulation and feedback/confidence surveys. Descriptive and univariate analyses were performed on participants' responses.
RESULTS
Twenty-three participants completed the simulation course. Eight (35%) had previous training with the course models. All training levels were represented. Participants reported higher rates of meaningful confidence, defined as moderate to complete on a Likert scale, for all simulated thoracic procedures (p < 0.05). The overall mean knowledge assessment score improved from 42.5% presimulation to 78.6% postsimulation, (p < 0.0001). When stratified by procedure, the mean scores for each simulated procedure showed statistically significant improvement, except for ruptured diaphragm repair (p = 0.45).
CONCLUSIONS
General thoracic surgery simulation provides a practical, inexpensive, and expedited learning experience in settings lacking experienced faculty and fellowship training opportunities. Resident feedback showed enhanced confidence and knowledge of thoracic procedures suggesting simulation surgery could be an effective tool in expanding the resident knowledge base and preparedness for performing clinically needed thoracic procedures. Repeated skills exposure remains a challenge for achieving sustainable progress.
背景
主要目标是在中低收入国家提供进行胸外科模拟的概念验证。次要目标是通过网站、模拟模型和当地教师的教学，加速普通外科住院医师的普通胸外科技能的掌握，并维持模拟手术教学。
方法
为在中低收入国家环境中使用而创建了五个培训模型，并在与卢旺达普通外科住院医师一起进行的现场课程中实施。创建了一个名为 http://thoracicsurgeryeducation.com 的网站，作为现场教学的补充。所有参与者在模拟前后都完成了课程知识评估以及反馈/信心调查。对参与者的回答进行了描述性和单变量分析。
结果
23 名参与者完成了模拟课程。其中 8 名（35%）有过课程模型的前期培训。所有培训水平都有代表。所有模拟胸科手术的参与者报告的有意义的信心率都更高，这被定义为在李克特量表上为中等至完全（p < 0.05）。总体知识评估得分从模拟前的 42.5%提高到模拟后的 78.6%（p < 0.0001）。按手术程序分层，除了破裂的横膈膜修复术（p = 0.45）外，每个模拟手术的平均分数都显示出统计学上的显著提高。
结论
普通胸外科模拟为缺乏经验丰富的教师和奖学金培训机会的环境提供了一种实用、廉价和快速的学习体验。住院医师的反馈表明，他们对胸科手术的信心和知识有所增强，这表明模拟手术可能是扩大住院医师知识库和为进行临床所需的胸科手术做好准备的有效工具。重复技能暴露仍然是实现可持续进展的挑战。
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