Clinical Trials Unit, Warwick Medical School, University Hospitals Coventry and Warwickshire, Coventry, UK.
Department of Trauma and Orthopaedic Surgery, University Hospitals Coventry and Warwickshire, Coventry, UK.
Br J Surg. 2019 Dec;106(13):1726-1734. doi: 10.1002/bjs.11325. Epub 2019 Oct 1.
BACKGROUND: There is growing interest in and provision of cadaveric simulation courses for surgical trainees. This is being driven by the need to modernize and improve the efficiency of surgical training within the current challenging training climate. The objective of this systematic review is to describe and evaluate the evidence for cadaveric simulation in postgraduate surgical training. METHODS: A PRISMA-compliant systematic literature review of studies that prospectively evaluated a cadaveric simulation training intervention for surgical trainees was undertaken. All relevant databases and trial registries were searched to January 2019. Methodological rigour was assessed using the widely validated Medical Education Research Quality Index (MERSQI) tool. RESULTS: A total of 51 studies were included, involving 2002 surgical trainees across 69 cadaveric training interventions. Of these, 22 assessed the impact of the cadaveric training intervention using only subjective measures, five measured impact by change in learner knowledge, and 23 used objective tools to assess change in learner behaviour after training. Only one study assessed patient outcome and demonstrated transfer of skill from the simulated environment to the workplace. Of the included studies, 67 per cent had weak methodology (MERSQI score less than 10·7). CONCLUSION: There is an abundance of relatively low-quality evidence showing that cadaveric simulation induces short-term skill acquisition as measured by objective means. There is currently a lack of evidence of skill retention, and of transfer of skills following training into the live operating theatre.
背景:越来越多的外科培训生对尸体模拟课程感兴趣并提供此类课程。这是由当前充满挑战的培训环境下,对现代化和提高外科培训效率的需求所驱动的。本系统评价的目的是描述和评估尸体模拟在研究生外科培训中的证据。
方法:对前瞻性评估尸体模拟培训干预对外科培训生的影响的研究进行了 PRISMA 符合的系统文献综述。搜索了所有相关数据库和试验登记处,检索时间截至 2019 年 1 月。使用广泛验证的医学教育研究质量指数(MERSQI)工具评估方法学严谨性。
结果:共纳入 51 项研究,涉及 69 项尸体培训干预措施中的 2002 名外科培训生。其中,22 项研究仅使用主观措施评估尸体培训干预的影响,5 项研究通过学习者知识的变化衡量影响,23 项研究使用客观工具评估培训后学习者行为的变化。只有一项研究评估了患者的结果,并证明了从模拟环境到工作场所的技能转移。纳入的研究中,67%的研究方法薄弱(MERSQI 评分低于 10.7)。
结论:有大量相对低质量的证据表明,尸体模拟可以通过客观手段诱导短期技能习得。目前缺乏技能保留和培训后技能转移到实际手术室的证据。
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