Singh Abhishek Gajendra
Fellow Endourology, Lapro-Robotic Surgery, Consultant Urologist, MPUH, NADIAD, Gujarat, India.
Indian J Urol. 2018 Oct-Dec;34(4):245-253. doi: 10.4103/iju.IJU_213_18.
Surgery is traditionally taught by using Halsteadian principle, which includes "see one, do one, teach one". This principle relies on sheer volume of surgical exposure rather than a specific course structure. Simulation in minimally invasive surgery allows the learner to practice new motor skills in a safe and stress free environment outside the operating room, thereby decreasing the learning curve. A non-structured exhaustive MEDLINE search was done using MeSH words: "Simulation, Urological Training, Training Models, Laparoscopy Urology, Laparoscopic Skill, Endotrainer, Surgical Simulators, Simulator Validation". The " Pros and Cons of simulation based training in laparoscopic urology" were studied. Results were discussed along the following lines : 1. How does skill acquisition occur? 2. Factors affecting simulator-based training. 3. Description of types of simulators and models. 4. Validating a simulator. 5. Task analysis after training on a simulator. 6. How effectively does simulation based training, translate into improved surgical performance in real time? Pros: Simulators have the ability to teach a novice basic psychomotor skills. Supervision and feedback enhance learning in a simulation-based training. They are supplements to and not a substitution for traditional method of teaching. These models can be used as a part of most of the surgical training curriculum. Cons: Cost and availability are the key issues. The cost will determine the availability of the simulators at a center and the availability in turn would determine whether a trainee will get the opportunity to use the simulator. Also, teacher training is an important aspect which would help teachers to understand the importance of simulation in student training. The domains in which it would improve and the extent to which simulation will improve surgical skills is dependent on various factors. Most simulators cannot train a surgeon to deal with anatomical and physiological variations. At present, it is not possible to re-validate all the surgeons in terms of their surgical skills, using simulators.
传统上，外科学是依据霍尔斯特德原则进行教学的，该原则包括“看一个，做一个，教一个”。这一原则依赖于大量的手术操作机会，而非特定的课程结构。微创手术模拟能让学习者在手术室之外的安全且无压力的环境中练习新的运动技能，从而缩短学习曲线。我们使用医学主题词进行了一次非结构化的全面MEDLINE检索：“模拟、泌尿外科培训、训练模型、腹腔镜泌尿外科、腹腔镜技能、内镜训练器、手术模拟器、模拟器验证”。我们研究了“腹腔镜泌尿外科基于模拟训练的利弊”。结果按照以下几个方面进行了讨论：1. 技能是如何习得的？2. 影响基于模拟器训练的因素。3. 模拟器和模型类型的描述。4. 模拟器的验证。5. 在模拟器上训练后的任务分析。6. 基于模拟的训练能多有效地实时转化为手术表现的提升？优点：模拟器有能力教授新手基本的心理运动技能。监督和反馈能增强基于模拟训练中的学习效果。它们是传统教学方法的补充而非替代。这些模型可作为大多数外科培训课程的一部分使用。缺点：成本和可用性是关键问题。成本将决定一个中心能否配备模拟器，而可用性反过来又会决定学员是否有机会使用模拟器。此外，教师培训是一个重要方面，它能帮助教师理解模拟在学生培训中的重要性。模拟能在哪些领域得到改进以及能在多大程度上提升手术技能取决于多种因素。大多数模拟器无法训练外科医生应对解剖和生理变异。目前，使用模拟器对所有外科医生的手术技能进行重新验证是不可能的。
