1 Department of Urology, Dalhousie University, Halifax, Canada.
2 Division of Urology, Department of Surgery, McMaster University, Hamilton, Canada.
J Endourol. 2019 Jun;33(6):463-467. doi: 10.1089/end.2018.0732. Epub 2019 Jan 2.
Simulation-based training (SBT) has become an increasingly popular modality to train novice surgical residents in the face of rapidly increasing innovative surgical techniques across all surgical disciplines. Recent studies have already demonstrated SBT to be effective in helping overcome the learning curve associated with new surgical techniques, especially in junior residents and endoscopic procedures. In addition, it is known that trainees benefit significantly from expert feedback; however, there is a paucity of data looking into the optimal timing of this feedback during SBT. To address this knowledge deficit, an SBT curriculum was developed for junior urology residents to assess optimal timing of feedback during SBT for flexible ureteroscopy (fURS). The SBT course consisted of a pretraining assessment, three independent practice sessions, and a post-training assessment, with residents receiving expert feedback right after their pretraining assessment (early feedback [EF]) or after their final independent training session (late feedback [LF]). Fifteen trainees with similar baseline fURS experience and precourse fURS task performance score participated in the study. There was a significant difference between the pre- and post-task completion times overall (15.2 minutes 9.1 minutes, < 0.001), with no difference between the early or LF groups ( = 0.884). The mean performance scores improved for both groups (18.2 24.2, < 0.001) with the EF group having a more statistically significant improvement in performance scores than the LF group ( = 0.05), and most (73%) of residents preferred EF. This study demonstrates that an SBT curriculum for fURS is effective for technical skills development among junior trainees, and that EF resulted in marginally better overall scores and was preferred by residents.
基于模拟的培训 (SBT) 已成为一种越来越流行的模式，可用于培训新手外科住院医师，以应对所有外科专业中快速创新的手术技术。最近的研究已经表明，SBT 有助于克服与新技术相关的学习曲线，尤其是在初级住院医师和内窥镜手术中。此外，众所周知，受训者从专家反馈中受益匪浅；然而，关于 SBT 期间反馈的最佳时机的数据却很少。为了弥补这一知识空白，为初级泌尿科住院医师开发了 SBT 课程，以评估 SBT 期间在软性输尿管镜检查 (fURS) 中反馈的最佳时机。SBT 课程包括培训前评估、三个独立的实践课程和培训后评估，住院医师在培训前评估后（早期反馈 [EF]）或最后一次独立培训课程后（晚期反馈 [LF]）收到专家反馈。15 名具有相似基础 fURS 经验和预课程 fURS 任务表现评分的受训者参加了该研究。总体而言，任务完成前后的时间有显著差异（15.2 分钟 9.1 分钟，<0.001），EF 组和 LF 组之间没有差异（=0.884）。两组的平均表现评分都有所提高（18.2 24.2，<0.001），EF 组的表现评分提高更为显著（=0.05），大多数（73%）住院医师更喜欢 EF。这项研究表明，fURS 的 SBT 课程对于初级住院医师的技术技能发展是有效的，EF 导致整体得分略有提高，并且更受住院医师的欢迎。
