Friedrich Mirco, Ober Julian, Haubruck Patrick, Bergdolt Christian, Bruckner Thomas, Kowalewski Karl-Friedrich, Kadmon Martina, Müller-Stich Beat-Peter, Tanner Michael Christopher, Nickel Felix
University of Heidelberg, Department of General, Visceral, and Transplantation Surgery, Heidelberg, Germany.
University of Heidelberg, HTRG - Heidelberg Trauma Research Group, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Trauma and Reconstructive Surgery, Heidelberg, Germany.
GMS J Med Educ. 2018 Nov 15;35(4):Doc48. doi: 10.3205/zma001194. eCollection 2018.
Chest tube insertion is a standard intervention for management of various injuries of the thorax. Efficient clinical training of this and similar bed-side procedures is equally demanded and improvable. Here, we propose a nouveau means of assessment and feedback using an Objective Structured Assessment of Technical Skills (OSATS) tool. The modified OSATS for chest drain insertion is evaluated in a pilot trial focusing on chest drain insertion. Participants in the pilot trial were medical students (3-6 year of studies, n=9), junior residents (1-3 post-graduate year, n=12), senior residents (4-6 post-graduate year, n=14), and attending surgeons (n=6) from Heidelberg University. Chest drain insertions on a cadaveric porcine model were rated by experts with the modified OSATS score. Participants' performances were videotaped and subsequently rated by two remote experts (video rating). Primary aim was to assess criterion validity of the OSATS to distinguish experience levels. Kruskal-Wallis test showed significant differences between means of scores between four groups stratified by previous experience in chest tube insertion (level 0: 22.1±3.2 vs. level 1: 26.8±2.8 vs. level 2: 35.4±2.2 vs. level 3: 41.0±2.0; p=0.002; p=0.049, p=0.005). However, if groups were stratified by formal professional level, no statistically significant distinction could be made using OSATS. Hence, the OSATS tool showed criterion validity for differentiation between experience levels. In the pilot study, the modified OSATS for chest tube insertion was apt to standardize expert rating and could be used to measure skill and to depict different experience levels. The OSATS will help facilitate training and assessment of chest drain insertion and could therefore improve surgical training for trauma situations. According to our data, the OSATS might be integrated into modern curricula.
胸腔闭式引流管置入术是治疗各种胸部损伤的标准干预措施。对该操作及类似床边操作进行高效的临床培训同样迫切且有改进空间。在此，我们提出一种使用客观结构化技术技能评估（OSATS）工具进行评估和反馈的新方法。针对胸腔闭式引流管置入术对改良后的OSATS进行了一项以胸腔闭式引流管置入术为重点的试点试验评估。试点试验的参与者为海德堡大学的医学生（学习3 - 6年，n = 9）、低年资住院医师（毕业后1 - 3年，n = 12）、高年资住院医师（毕业后4 - 6年，n = 14）以及主治外科医生（n = 6）。通过改良后的OSATS评分由专家对在尸体猪模型上进行的胸腔闭式引流管置入操作进行评分。参与者的操作过程被录像，随后由两名远程专家进行评分（视频评分）。主要目的是评估OSATS区分经验水平的标准效度。Kruskal - Wallis检验显示，根据既往胸腔闭式引流管置入经验分层的四组之间的平均得分存在显著差异（0级：22.1±3.2 vs. 1级：26.8±2.8 vs. 2级：35.4±2.2 vs. 3级：41.0±2.0；p = 0.002；p = 0.049，p = 0.005）。然而，如果按正式专业水平分层，则使用OSATS无法做出统计学上的显著区分。因此，OSATS工具显示出区分经验水平的标准效度。在试点研究中，改良后的胸腔闭式引流管置入术OSATS易于使专家评分标准化，可用于衡量技能并描绘不同的经验水平。OSATS将有助于促进胸腔闭式引流管置入术的培训和评估，从而改善创伤情况下的外科培训。根据我们的数据，OSATS可能会被纳入现代课程。
