Simmerman Erika, Simmerman Andrew, Lassiter Randi, King Ray, Ham Ben, Adam Bao-Ling, Ferdinand Colville, Holsten Steven
Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia.
Department of Surgery, Medical College of Georgia at Augusta University, Augusta, Georgia.
J Surg Educ. 2018 Sep-Oct;75(5):1188-1194. doi: 10.1016/j.jsurg.2018.03.012. Epub 2018 Apr 18.
As operative experience in general surgery decreases and work hour limitations increase there is less exposure of surgical residents to advanced vascular and trauma exposures. Many institutions have demonstrated benefits of cadaver laboratory courses. We have incorporated a multimedia cadaver laboratory course into our general surgery residency didactics curriculum with the objective to demonstrate a benefit of the program as well as the feasibility of incorporation.
This is a prospective study at a tertiary care institution including general surgery residents within our residency program. A curriculum was designed, requiring residents to complete multimedia learning modules before both a trauma cadaver laboratory and vascular exposure cadaver laboratory. Outcome measures included self-efficacy/confidence (precourse and postcourse 5-point Likert surveys), knowledge (net performance on precourse and postcourse multiple choice examinations), and resident perception of the curriculum (postcourse 5-point Likert survey). Data were analyzed using ANOVA paired t-tests.
For the vascular cadaver laboratory, resident knowledge improved overall from an average of 41.2% to 50.0% of questions correct (p = 0.032) and self-efficacy/confidence improved by 0.59 from 1.52 to 2.11 out of 5 (p = 0.009). Median confidence is 1.37 out of 5 and 2.32 out of 5, before and after course, respectively. Wilcoxon nonparametric test reveals a p = 0.011. Resident's perception of the usefulness of the laboratory evaluation was 3.85 out 5. There were 85.71% agreed that the laboratory is useful and 14.29% were disagree. The Z-score is -0.1579 (means 0.1579 standard deviations a score of 3.85 below the benchmark). The percentile rank is 56.27%. The coefficient of variation is 24.68%. For the trauma cadaver laboratory, resident knowledge improved overall from an average of 55.89% to 66.17% of questions correct (p = 0.001) and self-efficacy/confidence improved by 0.75 from 1.68 out of 5 to 2.43 out of 5 (p = 0.011). Median confidence level is 1.41 out of 5 before the training course and 2.64 out of 5 after the training course. Wilcoxon signed rank test gives a p value of 0.008. Resident's perception of the usefulness of the laboratory evaluation was 3.94 out 5. There were 72.22% agreed that the laboratory is useful and 27.78% were neutral. The Z-score is -0.098 (means 0.098 standard deviations a score of 3.94 below the benchmark). The percentile rank is 53.90%. The coefficient of variation is 15.48%.
Incorporating a multimedia cadaver laboratory into a residency education didactics curriculum was both feasible and beneficial for resident education. We demonstrate an improvement in knowledge and self efficacy/confidence following both cadaver laboratory courses.
随着普通外科手术经验的减少以及工作时间限制的增加，外科住院医师接触高级血管和创伤手术的机会减少。许多机构已证明尸体实验室课程的益处。我们将多媒体尸体实验室课程纳入普通外科住院医师教学课程，目的是证明该课程的益处以及纳入的可行性。
这是一项在三级医疗机构进行的前瞻性研究，研究对象包括我们住院医师培训项目中的普通外科住院医师。设计了一门课程，要求住院医师在创伤尸体实验室和血管暴露尸体实验室之前完成多媒体学习模块。结果指标包括自我效能感/信心（课程前后的5点李克特量表调查）、知识（课程前后多项选择题考试的净成绩）以及住院医师对课程的看法（课程后的5点李克特量表调查）。使用方差分析配对t检验对数据进行分析。
对于血管尸体实验室，住院医师的知识总体上从平均41.2%的正确问题率提高到50.0%（p = 0.032），自我效能感/信心从5分制中的1.52提高到2.11，提高了0.59（p = 0.009）。课程前后的中位数信心分别为5分制中的1.37和2.32。威尔科克森非参数检验显示p = 0.011。住院医师对实验室评估有用性的看法为5分制中的3.85。85.71%的人认为实验室有用，14.29%的人不同意。Z分数为-0.1579（意味着比基准分数3.85低0.1579个标准差）。百分等级为56.27%。变异系数为24.68%。对于创伤尸体实验室，住院医师的知识总体上从平均55.89%的正确问题率提高到66.17%（p = 0.001），自我效能感/信心从5分制中的1.68提高到2.43，提高了0.75（p = 0.011）。培训课程前的中位数信心水平为5分制中的1.41，培训课程后的中位数信心水平为5分制中的2.64。威尔科克森符号秩检验的p值为0.008。住院医师对实验室评估有用性的看法为5分制中的3.94。72.22%的人认为实验室有用，27.78%的人持中立态度。Z分数为-0.098（意味着比基准分数3.94低0.098个标准差）。百分等级为53.90%。变异系数为15.48%。
将多媒体尸体实验室纳入住院医师教育教学课程对住院医师教育既可行又有益。我们证明了在两个尸体实验室课程之后，知识和自我效能感/信心都有所提高。
