Indiana University Department of Surgery, Indianapolis.
Indiana University Department of Surgery, Indianapolis; Carolinas Medical Center, Charlotte, NC.
Surgery. 2019 Jun;165(6):1065-1068. doi: 10.1016/j.surg.2019.01.013. Epub 2019 Mar 18.
Expert performance is characterized by consistency. The degree of variability of performance from repetition to repetition during proficiency-based simulator training could potentially indicate acquisition of expertise. We hypothesized that learners with less variability in performance during simulator training would achieve greater performance at the end of training and improved transfer of skills to a live, anesthetized, porcine model.
The performance of 93 subjects (surgery residents and medical students) who had participated in 3 randomized controlled trials was analyzed for variability. All participants had trained in laparoscopic suturing on the Fundamentals of Laparoscopic Surgery (FLS) simulator. Their performance had been assessed on the simulator before (baseline) and after training (posttest) and on a live, anesthetized, porcine model (transfer test). We computed the coefficient of variations of suturing scores during training for each participant. Linear regression was used to assess whether variability in performance during training predicted posttest and transfer-test scores.
Decreased practice variability in performance was associated with greater scores in posttests and transfer tests. For each percent decrease in variability performance, posttest scores increased by 3.8 points (P < .001) and transfer-test scores increased by 3.0 points (P < .001). Greater mean scores during practice were associated with greater scores on the transfer test (P < .001).
Decreased variability in performance during practice on simulators is associated with improved performance at the end of training and during transfer to a live, anesthetized, porcine model. These findings suggest that variability in performance during simulator training may be used to track the progress and readiness of a trainee for the clinical environment. Further studies are needed to verify the robustness of this potentially new metric of performance.
专家表现的特点是一致性。在基于熟练程度的模拟器训练中，从一次重复到另一次重复的表现的可变性程度可能表明专业知识的获取。我们假设，在模拟器训练中表现变化较小的学习者在培训结束时的表现会更好，并且技能向活体、麻醉、猪模型的转移也会得到改善。
分析了 93 名（外科住院医师和医学生）参加了 3 项随机对照试验的受试者的表现变异性。所有参与者都在腹腔镜外科基本技能（FLS）模拟器上接受过腹腔镜缝合训练。他们在培训前（基线）和培训后（后测）以及活体麻醉猪模型（转移测试）上的表现都进行了评估。我们计算了每个参与者在培训过程中缝合得分的变异系数。线性回归用于评估培训过程中表现的可变性是否预测后测和转移测试分数。
表现可变性的减少与后测和转移测试的得分增加相关。每降低 1%的表现可变性，后测得分增加 3.8 分（P <.001），转移测试得分增加 3.0 分（P <.001）。练习过程中平均得分越高，转移测试的得分越高（P <.001）。
在模拟器上进行练习时，表现的可变性降低与培训结束时的表现提高以及向活体、麻醉、猪模型的转移有关。这些发现表明，模拟器训练过程中的表现可变性可以用来跟踪学员在临床环境中的进展和准备情况。需要进一步的研究来验证这种潜在的新表现指标的稳健性。
