Meling Trym R, Meling Torstein R
Faculty of Medicine, University of Oslo, Oslo, Norway.
Department of Clinical Neurosciences, Division of Neurosurgery, Geneva University Hospitals, Rue Gabriel-Perret-Gentil 5, 1205, Geneva, Switzerland.
Neurosurg Rev. 2021 Apr;44(2):843-854. doi: 10.1007/s10143-020-01314-2. Epub 2020 May 13.
The use of simulation in surgical training is ever growing. Evidence suggests such training may have beneficial clinically relevant effects. The objective of this research is to investigate the effects of surgical simulation training on clinically relevant patient outcomes by evaluating randomized controlled trials (RCT). PubMed was searched using PRISMA guidelines: "surgery" [All Fields] AND "simulation" [All Fields] AND "patient outcome" [All Fields]. Of 119 papers identified, 100 were excluded for various reasons. Meta-analyses were conducted using the inverse-variance random-effects method. Nineteen papers were reviewed using the CASP RCT Checklist. Sixteen studies looked at surgical training, two studies assessed patient-specific simulator practice, and one paper focused on warming-up on a simulator before performing surgery. Median study population size was 22 (range 3-73). Most articles reported outcome measures such as post-intervention Global Rating Scale (GRS) score and/or operative time. On average, the intervention group scored 0.42 (95% confidence interval 0.12 to 0.71, P = 0.005) points higher on a standardized GRS scale of 1-10. On average, the intervention group was 44% (1% to 87%, P = 0.04) faster than the control group. Four papers assessed the impact of simulation training on patient outcomes, with only one finding a significant effect. We found a significant effect of simulation training on operative performance as assessed by GRS, albeit a small one, as well as a significant reduction to operative time. However, there is to date scant evidence from RCTs to suggest a significant effect of surgical simulation training on patient outcomes.
手术模拟在外科培训中的应用日益广泛。有证据表明，这种培训可能会产生有益的临床相关效果。本研究的目的是通过评估随机对照试验（RCT）来调查手术模拟培训对临床相关患者结局的影响。按照PRISMA指南在PubMed数据库中进行检索：“手术”[所有字段] AND “模拟”[所有字段] AND “患者结局”[所有字段]。在检索到的119篇论文中，有100篇因各种原因被排除。采用逆方差随机效应方法进行荟萃分析。使用CASP RCT清单对19篇论文进行了审查。16项研究关注外科培训，2项研究评估针对特定患者的模拟器练习，1篇论文聚焦于手术前在模拟器上进行热身。研究人群规模的中位数为22（范围3 - 73）。大多数文章报告了干预后全球评分量表（GRS）得分和/或手术时间等结局指标。在1 - 10的标准化GRS量表上，干预组平均得分高0.42分（95%置信区间为0.12至0.71，P = 0.005）。平均而言，干预组比对照组快44%（1%至87%，P = 0.04）。4篇论文评估了模拟培训对患者结局的影响，只有1篇发现有显著效果。我们发现，经GRS评估，模拟培训对手术操作表现有显著影响，尽管影响较小，同时手术时间也显著缩短。然而，迄今为止，随机对照试验几乎没有证据表明手术模拟培训对患者结局有显著影响。
