Fischer Hans-Georg, Zehlicke Thorsten, Gey Alexandra, Rahne Torsten, Plontke Stefan K
Universitätsklinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie, Universitätsmedizin Halle, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale), Deutschland.
Abteilung für Hals-Nasen-Ohrenheilkunde, Kopf- und Hals-Chirurgie, Bundeswehrkrankenhaus Hamburg, Lesserstr. 180, 22049, Hamburg, Deutschland.
HNO. 2021 Jul;69(7):545-555. doi: 10.1007/s00106-020-00924-y.
Surgical training is increasingly supported by the use of simulators. For temporal bone surgery, shown here by means of mastoidectomy, there are other training models besides cadaver specimens, such as artificial temporal bones or computer-based simulators.
A structured training concept was created which integrates different training methods of mastoidectomy with regard to effectiveness and current learning theory in education.
A selective literature research was conducted to compare learning-theoretical findings and the availability and effectiveness of currently existing training models.
To acquire surgical skills, a stepwise approach is suggested. Depending on the progress with computer-based simulation, plastic or native temporal bones should be used. To achieve a plateau of the learning curve, approximately 25 semi-autonomous preparations are recommended. Different 'Objective Structured Assessments of Technical Skills' (OSATS) are implemented to assess the learning progress at different levels.
Simulation-based training is recommended until an adequate learning curve plateau is achieved. This is reasonable for patient safety, based on limited accessibility of human cadaveric temporal bones but also by findings of the learning theory.
The curriculum integrates different training models of mastoidectomy and OSATS into an overall concept. The training plan has to be continuously adapted to new findings and technical developments.
手术培训越来越多地借助模拟器进行。对于颞骨手术，以乳突切除术为例，除尸体标本外，还有其他培训模型，如人工颞骨或基于计算机的模拟器。
创建一个结构化培训概念，将乳突切除术的不同培训方法在教育效果和当前学习理论方面进行整合。
进行了一项选择性文献研究，以比较学习理论研究结果以及现有培训模型的可用性和有效性。
建议采用循序渐进的方法来掌握手术技能。根据基于计算机模拟的进展情况，应使用塑料或天然颞骨。为达到学习曲线的平稳期，建议进行约25次半自主操作。实施不同的“客观结构化技术技能评估”（OSATS）来评估不同阶段的学习进展。
建议进行基于模拟的培训，直到达到足够的学习曲线平稳期。这对于患者安全而言是合理的，一方面是因为人体尸体颞骨的获取有限，另一方面也是基于学习理论的研究结果。
该课程将乳突切除术的不同培训模型和OSATS整合到一个整体概念中。培训计划必须不断根据新的研究结果和技术发展进行调整。
