Department of Visceral, Thoracic and Vascular Surgery, University Hospital Dresden, Fetscherstraße 74, 01307, Dresden, Germany.
Chirurgische Klinik, Universitätsmedizin Mannheim, Medizinische Fakultät Mannheim, Universität Heidelberg, Mannheim, Germany.
Surg Endosc. 2018 Oct;32(10):4132-4137. doi: 10.1007/s00464-018-6156-6. Epub 2018 Mar 30.
Skill transfer represents an important issue in surgical education, and is not well understood. The aim of this randomized study is to assess the transferability of surgical skills between two laparoscopic abdominal procedures using the virtual reality simulator in surgical novices.
From September 2016 to July 2017, 44 surgical novices were randomized into two groups and underwent a proficiency-based basic training consisting of five selected simulated laparoscopic tasks. In group 1, participants performed an appendectomy training on the virtual reality simulator until they reached a defined proficiency. They moved on to the tutorial procedural tasks of laparoscopic cholecystectomy. Participants in group 2 started with the tutorial procedural tasks of laparoscopic cholecystectomy directly. Finishing the training, participants of both groups were required to perform a complete cholecystectomy on the simulator. Time, safety and economy parameters were analysed.
Significant differences in the demographic characteristics and previous computer games experience between the two groups were not noted. Both groups took similar time to complete the proficiency-based basic training. Participants in group 1 needed significantly less movements (388.6 ± 98.6 vs. 446.4 ± 81.6; P < 0.05) as well as shorter path length (810.2 ± 159.5 vs. 945.5 ± 187.8 cm; P < 0.05) to complete the cholecystectomy compared to group 2. Time and safety parameters did not differ significantly between both groups.
The data demonstrate a positive transfer of motor skills between laparoscopic appendectomy and cholecystectomy on the virtual reality simulator; however, the transfer of cognitive skills is limited. Separate training curricula seem to be necessary for each procedure for trainees to practise task-specific cognitive skills effectively. Mentoring could help trainees to get a deeper understanding of the procedures, thereby increasing the chance for the transfer of acquired skills.
技能转移是外科教育中的一个重要问题，但目前人们对此了解甚少。本随机研究的目的是评估新手使用虚拟现实模拟器在两种腹腔镜腹部手术之间转移手术技能的能力。
2016 年 9 月至 2017 年 7 月，将 44 名外科新手随机分为两组，进行基于熟练程度的基础培训，包括 5 项选定的模拟腹腔镜任务。在第 1 组中，参与者在虚拟现实模拟器上进行阑尾切除术培训，直到达到规定的熟练程度。然后他们进行腹腔镜胆囊切除术的教程程序任务。第 2 组的参与者直接从教程程序任务开始。完成培训后，两组参与者都需要在模拟器上完成完整的胆囊切除术。分析时间、安全性和经济性参数。
两组间的人口统计学特征和之前的电脑游戏经验无显著差异。两组完成基于熟练程度的基础培训所需的时间相似。第 1 组参与者完成胆囊切除术所需的动作明显减少（388.6±98.6 比 446.4±81.6；P<0.05），路径长度也更短（810.2±159.5 比 945.5±187.8cm；P<0.05）。两组间的时间和安全性参数无显著差异。
数据表明，在虚拟现实模拟器上，腹腔镜阑尾切除术和胆囊切除术之间存在积极的运动技能转移；然而，认知技能的转移是有限的。对于学员来说，每个手术都需要单独的培训课程，以便有效地练习特定任务的认知技能。指导可以帮助学员更深入地了解手术过程，从而增加所获得技能转移的机会。
