将机器人技术融入住院医师培训：来自一线的挑战和建议。
Integrating Robotic Technology Into Resident Training: Challenges and Recommendations From the Front Lines.
机构信息
C.A. Green is a general surgery resident, University of California, San Francisco, San Francisco, California. K.M. Mahuron is a general surgery resident, University of California, San Francisco, San Francisco, California. H.W. Harris is professor and chief, Division of General Surgery, J. Engelbert Dunphy Endowed Chair in Surgery, and program director, National Institutes of Health T32 Training Program in Gastrointestinal Surgery, Department of Surgery, University of California, San Francisco, San Francisco, California. P.S. O'Sullivan is professor, Departments of Medicine and Surgery, and director of research and development in medical education, Center for Faculty Educators, University of California, San Francisco School of Medicine. She is also endowed chair of surgical education, Department of Surgery, University of California, San Francisco, San Francisco, California.
出版信息
Acad Med. 2019 Oct;94(10):1532-1538. doi: 10.1097/ACM.0000000000002751.
PURPOSE
To develop recommendations for improving the integration of robotic technology into today's apprentice-based resident training.
METHOD
During a national meeting in 2017, 24 robotic surgeons were interviewed about their experiences integrating robotic technology into resident training. Qualitative thematic analysis of interview notes and recordings revealed themes related to challenges and recommendations.
RESULTS
Four themes emerged, each corresponding to a general recommendation for integrating robotic technology into training. The first, surgical techniques versus tools, contrasts faculty's sequential mastery-surgical techniques first, then the robotic tool-with residents' simultaneous learning. The recommendation is to create separate learning opportunities for focused skill acquisition. The second theme, timing of exposure to the robotic tool, describes trainees' initial focus on tool use for basic surgical steps. The recommendation is to increase access to basic robotic cases. The third theme covers the relationship of laparoscopic and robotic surgery. The recommendation is to emphasize similar and dissimilar features during all minimally invasive surgical cases. The fourth theme, use of the dual console (which enables two consoles to operate the robot, the primary determines the secondary's functionality), highlights the unique teaching opportunities this console creates. The recommendation is for surgeons to give verbal guidance so residents completely understand surgical techniques.
CONCLUSIONS
Surgical educators should consider technique versus tool, timing of exposure to the tool, overlapping and varying features of robotic and laparoscopic surgery, and use of the dual console as they develop curricula to ensure thorough acquisition and synthesis of all elements of robotic surgery.
目的
为了提出改进将机器人技术整合到目前基于学徒制的住院医师培训中的建议。
方法
在 2017 年的一次全国会议上，对 24 名机器人外科医生进行了采访，了解他们将机器人技术整合到住院医师培训中的经验。对访谈记录和录音的定性主题分析揭示了与挑战和建议相关的主题。
结果
出现了四个主题，每个主题都对应着将机器人技术整合到培训中的一般建议。第一个主题是手术技术与工具的对比，这与教师的顺序掌握——先掌握手术技术，然后再掌握机器人工具——与住院医师的同步学习形成对比。建议是为有针对性的技能获取创建单独的学习机会。第二个主题是接触机器人工具的时间，描述了受训者最初专注于使用工具进行基本手术步骤。建议是增加获得基本机器人病例的机会。第三个主题涵盖了腹腔镜手术和机器人手术的关系。建议是在所有微创外科病例中强调类似和不同的特征。第四个主题是双控制台的使用（允许两个控制台操作机器人，主控制台决定次控制台的功能），突出了该控制台创造的独特教学机会。建议外科医生进行口头指导，以便住院医师完全理解手术技术。
结论
外科教育者在制定课程时应考虑技术与工具、接触工具的时间、机器人和腹腔镜手术的重叠和不同特征以及双控制台的使用，以确保全面彻底地掌握机器人手术的所有要素。
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