Bachand Jennifer, Schroeder Samuel R, Desai Neil B, Folkert Michael R
UT Southwestern Medical School, Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas, TX USA.
Department of Radiation Oncology, Simmons Comprehensive Cancer Center at the University of Texas Southwestern Medical Center, Dallas, TX USA.
J Contemp Brachytherapy. 2019 Dec;11(6):601-606. doi: 10.5114/jcb.2019.90984. Epub 2019 Dec 16.
Inadequate procedural training is of increasing concern in resident training, especially in prostate brachytherapy (PB). Transperineal rectal spacer placement (TRSP) requires many of the same proficiencies as PB. This work describes the assessment of teaching techniques focusing on developing critical competencies for PB using related clinical procedures (TRSP).
For PB and TRSP, key competencies were identified: 9 for PB and 7 for TRSP; 4 are shared between PB and TRSP. "Comfort level" with these procedures was assessed prior to and following participation in TRSP.
8 of 12 trainees at our institution participated in TRSP procedures. 2 of these trainees had prior experience with PB or related procedures and were excluded. Trainees self-reported "comfort levels" between 0 and 3 for four competency domains. Initial median comfort (MC) level for competency domains relevant to PB included: patient positioning (median 1, range 0-2), transrectal ultrasound imaging (median 1, range 0-1), fiducial placement (median 1, range 0-1), and hydrodissection (median 0, range 0-1). Median number of TRSP procedures performed by assessed trainees during the analysis period was 4 (range 1-6). Following TRSP procedure training, MC level increased: 2 points for patient positioning (median 3, range 1-3; < 0.01), 1.5 points for transrectal ultrasound imaging (median 2.5, range 1.3, < 0.001); 1 point for fiducial placement (median score 2, range 1-3; < 0.001); and 1.5 points for hydrodissection (median score 2, range 1-3; < 0.001).
Increasing trainee involvement in related procedures to develop core competencies may help facilitate increased comfort with common skills critical to the independent performance of PB.
在住院医师培训中，程序训练不足日益受到关注，尤其是在前列腺近距离放射治疗（PB）方面。经会阴直肠间隔置入术（TRSP）所需的许多技能与PB相同。本研究描述了通过相关临床程序（TRSP）来培养PB关键能力的教学技术评估。
确定了PB和TRSP的关键能力：PB为9项，TRSP为7项；其中4项是PB和TRSP共有的。在参与TRSP之前和之后，评估了对这些程序的“舒适度”。
我们机构的12名学员中有8名参与了TRSP程序。其中2名学员有PB或相关程序的经验，被排除在外。学员对四个能力领域的自我报告“舒适度”在0至3之间。与PB相关的能力领域的初始中位舒适度（MC）水平包括：患者体位（中位值1，范围0 - 2）、经直肠超声成像（中位值1，范围0 - 1）、基准点放置（中位值1，范围0 - 1）和水分离术（中位值0，范围0 - 1）。在分析期间，接受评估的学员进行TRSP程序的中位次数为4次（范围1 - 6次）。经过TRSP程序培训后，MC水平有所提高：患者体位提高2分（中位值3，范围1 - 3；<0.01），经直肠超声成像提高1.5分（中位值2.5，范围1.3，<0.001）；基准点放置提高1分（中位得分2，范围1 - 3；<0.001）；水分离术提高1.5分（中位得分2，范围1 - 3；<0.001）。
增加学员参与相关程序以培养核心能力，可能有助于提高学员对PB独立操作至关重要的常见技能的舒适度。
