a Department of Surgery , Herlev Gentofte Hospital , Herlev , Denmark.
b Copenhagen Academy for Medical Education and Simulation, University of Copenhagen and the Capital Region of Denmark , Copenhagen , Denmark.
Med Teach. 2018 Jul;40(7):668-675. doi: 10.1080/0142159X.2018.1472754. Epub 2018 Jun 17.
Simulation-based training (SBT) has become a standard component of modern surgical education, yet successful implementation of evidence-based training programs remains challenging. In this narrative review, we use Kern's framework for curriculum development to describe where we are now and what lies ahead for SBT within surgery with a focus on technical skills in operative procedures. Despite principles for optimal SBT (proficiency-based, distributed, and deliberate practice) having been identified, massed training with fixed time intervals or a fixed number of repetitions is still being extensively used, and simulators are generally underutilized. SBT should be part of surgical training curricula, including theoretical, technical, and non-technical skills, and be based on relevant needs assessments. Furthermore, training should follow evidence-based theoretical principles for optimal training, and the effect of training needs to be evaluated using relevant outcomes. There is a larger, still unrealized potential of surgical SBT, which may be realized in the near future as simulator technologies evolve, more evidence-based training programs are implemented, and cost-effectiveness and impact on patient safety is clearly demonstrated.
基于模拟的培训（SBT）已经成为现代外科教育的标准组成部分，但成功实施基于证据的培训计划仍然具有挑战性。在这篇叙述性评论中，我们使用 Kern 的课程开发框架来描述我们现在所处的位置，以及 SBT 在外科领域（重点是手术中的技术技能）的未来发展方向。尽管已经确定了 SBT 的最佳原则（基于熟练程度、分散和刻意练习），但仍然广泛使用集中培训，即具有固定时间间隔或固定重复次数的培训，而模拟器的使用通常不足。SBT 应该成为外科培训课程的一部分，包括理论、技术和非技术技能，并应基于相关的需求评估。此外，培训应遵循基于证据的最佳培训理论原则，并且需要使用相关结果来评估培训效果。外科 SBT 的潜力更大，但尚未实现，随着模拟器技术的发展、更多基于证据的培训计划的实施，以及成本效益和对患者安全的影响得到明确证明，这种潜力可能在不久的将来实现。
