Obstetrics and Gynecology, University of Helsinki and Helsinki University Hospital, P.O. Box 100, 00029 HUS, Helsinki, Finland.
Helsinki University Hospital, P.O. Box 100, 00029 HUS, Helsinki, Finland.
Surg Endosc. 2019 Nov;33(11):3688-3695. doi: 10.1007/s00464-018-06657-y. Epub 2019 Jan 17.
Gynecological surgery and resident education have changed during recent decades, thus impacting surgical training. Training on simulators must begin before operating on patients. The objective of this study was to evaluate the effect of a simple curriculum on the surgical outcome of the participants' first operative laparoscopy.
This randomized prospective interventional study was carried out in Helsinki University Hospital and Hyvinkää Hospital. We recruited twenty junior residents in Obstetrics and Gynecology, of which half formed a control group and the rest completed the intervention with a theoretical and a practical part. The participants' first laparoscopic salpingectomy was assessed from video recordings by using Objective Structured Assessment of Technical Skills (OSATS) forms and the Numeric Rating Scale (NRS). The surgical outcome and assessed scores were compared between the groups.
We found no differences in operative time, blood loss, or complications, nor in OSATS or NRS scores. In the intervention group, participants with the weakest performances in the simulator, seemed to benefit from the training program more than the participants with the best performances (skill level elevation 29.2-31.6% vs. 21.1-23.3%, respectively). The participants with the best performances in the simulator were scored among the best in the recorded operations as well.
In this study, we found no difference in the surgical outcome between the groups. However, the participants with low starting levels in the simulator could elevate their skill levels more, though they did not reach the skill level of those with a high starting level. Consequently, we found elevation in skills levels in the simulator tasks, but not in the surgical outcome. Likely, our simple training program with a fixed number of repetitions was insufficient to reach a plateau in the learning curve, and thus the training program in such a curriculum should be proficiency based.
近几十年来，妇科手术和住院医师教育发生了变化，从而影响了手术培训。在为患者做手术之前，必须在模拟器上进行培训。本研究的目的是评估一个简单课程对参与者第一次手术腹腔镜检查手术结果的影响。
这项随机前瞻性干预研究在赫尔辛基大学医院和 Hyvinkää 医院进行。我们招募了 20 名妇产科初级住院医师，其中一半为对照组，其余一半完成了理论和实践两部分的干预。通过使用客观结构化评估技术技能（OSATS）表格和数字评分量表（NRS），从视频记录中评估参与者的第一次腹腔镜输卵管切除术。比较两组的手术结果和评估分数。
我们发现手术时间、出血量或并发症、OSATS 或 NRS 评分均无差异。在干预组中，模拟器表现最差的参与者似乎比表现最好的参与者从培训计划中受益更多（技能水平提升 29.2-31.6%对 21.1-23.3%）。模拟器表现最好的参与者在记录的手术中也获得了最佳评分。
在这项研究中，我们发现两组之间的手术结果没有差异。然而，模拟器起点较低的参与者可以提高他们的技能水平，尽管他们无法达到起点较高的参与者的技能水平。因此，我们发现模拟器任务中的技能水平有所提高，但手术结果没有提高。可能是我们的简单培训计划，加上固定的重复次数，不足以达到学习曲线的平台，因此这种课程的培训计划应该以熟练程度为基础。
