模拟训练后环形电切术（LEEP）中实习生的表现。

Trainee Performance in Loop Electrosurgical Excision Procedure (LEEP) After Simulation Training.

机构信息

University of Queensland Faculty of Medicine, Brisbane, Queensland, Australia.

Mater Health, Brisbane, Queensland, Australia.

出版信息

J Low Genit Tract Dis. 2019 Jan;23(1):28-32. doi: 10.1097/LGT.0000000000000443.

DOI:10.1097/LGT.0000000000000443

PMID:30376485

Abstract

OBJECTIVE

The aim of the study was to review the performance of trainees in loop electrosurgical excision procedure (LEEP) procedures after the introduction of a simulation training program.

MATERIALS AND METHOD

A simulation training program was introduced in September 2016 for gynecology trainees at the study institution. Trainees were encouraged to perform at least 3 simulated LEEP procedures before operating. For a 12-month period after the introduction of training, data on operating time and specimen quality measures of clear margin status, adequate depth, and absence of fragmentation were reviewed. This was compared with a 12-month period before simulation training (from September 2014-September 2015). Trainees were surveyed for feedback on the training.

RESULTS

In total, 135 LEEP procedures were reviewed: 68 before and 67 after simulator training. Trainee specimens after training were more likely to be nonfragmented (89.2% vs 55.9%, p = .003), have clear margins (72.2% vs 41.9%, p = .015), and meet "all criteria" (46% vs 20.6%, p = .043) than trainee specimens before training. There was no change in depth adequacy (70.3% vs 67.7%, p = .99). Median trainee procedure time reduced from 18 minutes (interquartile range = 11-24) before training to 8 minutes after training (interquartile range = 6-11) (p = <0.001). There was no significant change in operating time or specimen quality from LEEP procedures performed by attendings (who did not use the simulator). Trainee and attending procedural outcomes were similar after training. Trainees had mostly positive views on the training, though reported time constraints as a barrier to simulation.

CONCLUSIONS

After the introduction of an LEEP simulation training program, operative time and specimen quality from trainee procedures seemed to improve.

摘要

目的

本研究旨在评估引入模拟培训计划后，受训者在环行电切术（LEEP）中的表现。

材料与方法

自 2016 年 9 月起，本研究机构为妇科受训者引入了模拟培训计划。受训者被鼓励在进行实际操作前至少完成 3 次模拟 LEEP 操作。在培训引入后的 12 个月内，我们回顾了手术时间和标本质量的各项指标，包括切缘状态清晰、深度足够和无碎片等。这与培训前的 12 个月（2014 年 9 月至 2015 年 9 月）进行了比较。我们对培训的反馈进行了问卷调查。

结果

共回顾了 135 例 LEEP 操作：培训前 68 例，培训后 67 例。培训后，受训者的标本更不容易出现碎片（89.2%比 55.9%，p=0.003），切缘更清晰（72.2%比 41.9%，p=0.015），且符合“所有标准”（46%比 20.6%，p=0.043）的比例更高。深度充足的比例没有变化（70.3%比 67.7%，p=0.99）。受训者的手术时间中位数从培训前的 18 分钟（四分位间距 11-24）减少到培训后的 8 分钟（四分位间距 6-11）（p<0.001）。主治医生（未使用模拟器）进行的 LEEP 操作的手术时间或标本质量没有显著变化。培训后，受训者和主治医生的操作结果相似。尽管受训者认为时间限制是模拟的障碍，但他们对培训的看法大多是积极的。