From the Hansjörg Wyss Department of Plastic Surgery, New York University Langone Health.
Plast Reconstr Surg. 2020 Jan;145(1):184e-192e. doi: 10.1097/PRS.0000000000006375.
Simulation is a standard component of residency training in many surgical subspecialties, yet its impact on knowledge and skills acquisition in plastic surgery training remains poorly defined. The authors evaluated the potential benefits of simulation-based cleft surgery learning in plastic surgery resident education through a prospective, randomized, blinded trial.
Thirteen plastic surgery residents were randomized to a digital simulator or textbook demonstrating unilateral cleft lip repair. The following parameters were evaluated before and after randomization: knowledge of surgical steps, procedural confidence, markings performance on a three-dimensional stone model, and surgical performance using a hands-on/high-fidelity three-dimensional haptic model. Participant satisfaction with either educational tool was also assessed. Two expert reviewers blindly graded markings and surgical performance. Intraclass correlation coefficients were calculated. Wilcoxon signed rank and Mann-Whitney U tests were used.
Interrater reliability was strong for preintervention and postintervention grading of markings [preintervention intraclass correlation coefficient, 0.97 (p < 0.001); postintervention intraclass correlation coefficient, 0.96 (p < 0.001)] and surgical [preintervention intraclass correlation coefficient, 0.83 (p = 0.002); postintervention intraclass correlation coefficient, 0.81 (p = 0.004)] performance. Postintervention surgical knowledge (40.3 ± 4.4 versus 33.5 ± 3.7; p = 0.03), procedural confidence (24.0 ± 7.0 versus 14.7 ± 2.3; p = 0.03), markings performance (8.0 ± 2.5 versus 2.9 ± 3.1; p = 0.03), and surgical performance (12.3 ± 2.5 versus 8.2 ± 2.3; p = 0.04) significantly improved in the digital simulation group compared with before intervention, but not in the textbook group. All participants were more satisfied with the digital simulator as an educational tool (27.7 ± 2.5 versus 14.4 ± 4.4; p < 0.001).
The authors present evidence suggesting that digital cognitive simulators lead to significant improvement in surgical knowledge, procedural confidence, markings performance, and surgical performance.
模拟是许多外科亚专业住院医师培训的标准组成部分，但它对整形外科学培训中知识和技能获取的影响仍未得到明确界定。作者通过前瞻性、随机、盲法试验评估了基于模拟的腭裂手术学习在整形住院医师教育中的潜在益处。
13 名整形住院医师随机分为数字模拟器组或教科书组，分别演示单侧唇裂修复术。在随机分组前后评估以下参数：手术步骤知识、程序信心、三维石模型标记表现以及使用实物/高保真三维触觉模型的手术表现。还评估了参与者对两种教育工具的满意度。两位专家评审员对标记和手术表现进行了盲法评分。计算了组内相关系数。使用 Wilcoxon 符号秩和 Mann-Whitney U 检验。
术前和术后标记评分的观察者间可靠性很强[术前组内相关系数，0.97（p<0.001）；术后组内相关系数，0.96（p<0.001）]和手术[术前组内相关系数，0.83（p=0.002）；术后组内相关系数，0.81（p=0.004）]表现。术后手术知识（40.3±4.4 比 33.5±3.7；p=0.03）、程序信心（24.0±7.0 比 14.7±2.3；p=0.03）、标记表现（8.0±2.5 比 2.9±3.1；p=0.03）和手术表现（12.3±2.5 比 8.2±2.3；p=0.04）在数字模拟组中明显优于干预前，但在教科书组中没有改善。所有参与者对数字模拟器作为教育工具更满意（27.7±2.5 比 14.4±4.4；p<0.001）。
作者提供的证据表明，数字认知模拟器可显著提高手术知识、程序信心、标记表现和手术表现。
