Hyde G Alan, Soder Brent L, Stanley J Daniel, Dart Benjamin W, Holcombe Jenny M, Cook Richard G, Burns R Phillip, Nelson Eric C
Am Surg. 2018 Nov 1;84(11):1801-1807.
Because work hour restrictions and technological developments such as staplers change the surgical landscape, efficient resident training methods are necessary to ensure surgical quality. This study evaluates efficacy of a porcine skills laboratory for teaching surgery residents to perform handsewn intestinal anastomoses based on a validated subjective tool and novel objective measurements. We hypothesized that resident performance would improve postintervention; junior residents would improve more than the seniors would. This prospective study was completed over a period of four months in 2015. Participants performed standardized two-layer, handsewn, end-to-end small intestine anastomosis in a live porcine model before (pretest) and after (posttest) an educational intervention. The intervention consisted of an instructional module and skills laboratory teaching session by attending surgeons. Participants were evaluated based on objective measurements of the anastomosis and blinded video evaluations using objective structured assessment of technical skills. Twenty-eight residents in a six-year general surgery program started and completed the study. The objective structured assessment of technical skills ratings demonstrated that the whole resident cohort had statistically significant improvement in pre- to posttest scores, 11.16 to 24.59 ( < 0.001). Junior and senior residents improved independently, 9.59 22.53 ( < 0.001) and 13.59 27.77 ( < 0.001), respectively. Finally, the cohort significantly improved in number of full-thickness Lembert sutures (2.36 0.93, = 0.001) and time to completion (31.28 28.2 minutes, = 0.046). Anastomotic leak pressure, anastomotic narrowing, and anastomotic tensile strength all trended toward improvement. A structured educational intervention, teaching intestinal anastomosis in a live porcine model produced significant improvement in residents' technical skills.
由于工作时间限制以及诸如吻合器等技术发展改变了外科手术格局，因此需要高效的住院医师培训方法来确保手术质量。本研究基于一种经过验证的主观工具和新颖的客观测量方法，评估了猪技能实验室在教授外科住院医师进行手工缝合肠吻合术方面的效果。我们假设住院医师的表现会在干预后得到改善；初级住院医师的改善幅度会大于高级住院医师。这项前瞻性研究于2015年历时四个月完成。参与者在教育干预前（预测试）和后（后测试），于活猪模型中进行标准化的两层手工缝合端端小肠吻合术。干预措施包括由主治外科医生进行的教学模块和技能实验室教学课程。根据吻合术的客观测量结果以及使用客观结构化技术技能评估的盲法视频评估对参与者进行评估。一个为期六年的普通外科项目中的28名住院医师开始并完成了该研究。客观结构化技术技能评分显示，整个住院医师队列的预测试到后测试分数有统计学意义的提高，从11.16提高到24.59（<0.001）。初级和高级住院医师分别独立改善，分别为9.59至22.53（<0.001）和13.59至27.77（<0.001）。最后，该队列在全层伦伯特缝针数量（2.36±0.93，P = 0.001）和完成时间（31.28±28.2分钟，P = 0.046）方面有显著改善。吻合口漏压力、吻合口狭窄和吻合口抗张强度均有改善趋势。在活猪模型中进行肠吻合术的结构化教育干预显著提高了住院医师的技术技能。
