Department of Surgery, College of Medicine, University of Arizona, 1501 N. Campbell Avenue, P.O. Box 245066, Tucson, AZ, 85724-5066, USA.
Department of Surgery, Medstar Washington Hospital Center, Washington, DC, USA.
Surg Endosc. 2021 Jul;35(7):3370-3378. doi: 10.1007/s00464-020-07778-z. Epub 2020 Jul 8.
The objective of this study was to examine the impact of an intensive laparoscopic training course incorporating structured assessment and immediate feedback on residents' operative performance in animal lab.
Surgical residents participated in a 2-day intensive laparoscopic training course. They performed the same procedures on two consecutive days on live pigs. Junior residents (PGY1-2) performed laparoscopic cholecystectomy and incisional hernia repair and the senior residents (PGY3-5) performed laparoscopic Nissen fundoplication, splenectomy, and low anterior colon resection. Assessment tools with proven validity evidence (global and procedure-specific rating tools for operative assessment of laparoscopic skills) were used to assess their operative performance. Faculty assessment and self-assessments were completed immediately after each procedure on both days. The Wilcoxon rank test was used to examine the effect of training on resident performance after one repetition.
Forty surgical residents (20 junior and 20 senior residents) participated. There was a significant improvement in general laparoscopic skills during incisional hernia repair and Nissen fundoplication using global rating scales (p < 0.05). Moreover, there was an improvement in their performance during cholecystectomy, incisional hernia repair, and low anterior colectomy when procedure-specific skills assessments were used (p < 0.05). There was a positive correlation between residents' self-reported confidences and their operative performance CONCLUSION: Trainees showed significant improvements in performance in general and procedure-specific laparoscopic skills in a wide range of procedures after an intensive training course. This study demonstrates the benefit of a structured training curriculum in improving operative performance in basic and advanced laparoscopic skills in a simulated environment. Future studies are needed to examine the duration of training required to achieve skill retention and competency.
本研究旨在探讨在动物实验室中，纳入结构化评估和即时反馈的强化腹腔镜培训课程对住院医师手术操作表现的影响。
外科住院医师参加了为期两天的强化腹腔镜培训课程。他们在连续两天的时间里，在活体猪上进行相同的手术。初级住院医师（PGY1-2）进行腹腔镜胆囊切除术和切口疝修补术，而高级住院医师（PGY3-5）进行腹腔镜 Nissen 胃底折叠术、脾切除术和低位前结肠切除术。使用具有经过验证的有效性证据的评估工具（用于腹腔镜技能手术评估的总体和特定手术的评估工具）来评估他们的手术操作表现。在两天的每一次手术后，立即完成教员评估和自我评估。使用 Wilcoxon 秩检验检验培训对住院医师一次重复后的操作表现的影响。
共有 40 名外科住院医师（20 名初级住院医师和 20 名高级住院医师）参加了该研究。使用总体评估量表，在切口疝修补术和 Nissen 胃底折叠术中，整体腹腔镜技能有显著提高（p<0.05）。此外，当使用特定手术技能评估时，在胆囊切除术、切口疝修补术和低位前结肠切除术中，他们的手术表现也有所提高（p<0.05）。住院医师自我报告的信心与他们的手术表现之间存在正相关关系。
在强化培训课程后，受训者在广泛的手术中，在总体和特定手术的腹腔镜技能方面表现出显著的进步。本研究表明，在模拟环境中，结构化培训课程有助于提高基本和高级腹腔镜技能的手术操作表现。未来的研究需要检验实现技能保持和能力所需的培训时间长度。
