Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Division of Cardiovascular Surgery, Department of Surgery, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Division of Cardiology, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada; Department of Diagnostic Imaging, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada.
Ann Thorac Surg. 2021 Nov;112(5):1672-1680. doi: 10.1016/j.athoracsur.2020.11.018. Epub 2020 Dec 9.
The monthly in-house Hands-On Surgical Training (HOST) program was incorporated into the congenital heart surgery (CHS) curriculum for surgical trainees within our institution. This study evaluated whether there was an improvement and retention of technical skills throughout the curriculum via objective assessment methods.
Twelve 3-dimensional-printed surgical heart models were included into the year-long curriculum. The monthly sessions were attended by all trainees and staff surgeons. Proctors demonstrated the operation on a model, which was followed by 2 attempts by each trainee. Attempts were recorded for objective assessment. On completion of the curriculum trainees repeated 4 procedures an additional 2 times after a delay to assess skill retention.
Twelve sessions were completed by 7 trainees within the curriculum. Objective assessments were performed in 7 sessions. Eighty-one percent of trainees' scores improved between the 2 attempts, with a mean improvement of 13% (attempt 1: HOST-CHS score of 79, attempt 2: HOST-CHS score of 89; P < .001). Similarly, 91% of procedural times improved by a mean of 25% (attempt 1, 1:22:00 [hours:minutes:seconds]; attempt 2, 1:01:21; P < .001). During individual procedure analysis, statistical significance remained in 3 of 7 procedures (P < .05). Four procedures were assessed for skill retention after a delay (2-14 months). Scores decreased by 4% in 47% of trainees during attempt 3 (attempt 2: HOST-CHS score of 94, attempt 3: HOST-CHS score of 91; P = .34) but improved in 79% during attempt 4 (attempt 3: HOST-CHS score of 91, attempt 4: HOST-CHS score of 99; P = .004), matching their previous performance.
The monthly HOST course was successfully incorporated into a training curriculum for CHS surgeons using objective assessments to measure technical performance. Trainees demonstrated an improvement across all evaluated procedures and retained their skills when reassessed after a delay highlighting its value in CHS training.
我们机构将每月的实地手术培训（HOST）计划纳入了心胸外科（CHS）培训生的课程中。本研究通过客观评估方法评估了整个课程是否能够提高和保持技术技能。
将 12 个 3D 打印的心脏手术模型纳入为期一年的课程中。所有受训者和主治外科医生都参加了每月的课程。指导医生在模型上演示手术，然后每个受训者进行 2 次尝试。尝试过程被记录下来用于客观评估。在课程结束后，受训者在延迟后额外重复进行了 4 次操作，以评估技能保留情况。
7 名受训者在课程中完成了 12 次课程。在 7 次课程中进行了客观评估。81%的受训者的分数在两次尝试之间有所提高，平均提高了 13%（尝试 1：HOST-CHS 得分为 79，尝试 2：HOST-CHS 得分为 89；P<.001）。同样，91%的操作时间缩短了 25%（尝试 1：1:22:00[小时：分钟：秒]；尝试 2：1:01:21；P<.001）。在个别手术分析中，有 3 项手术的统计学意义仍然显著（P<.05）。4 项手术在延迟后（2-14 个月）进行了技能保留评估。在尝试 3 中，47%的受训者的分数下降了 4%（尝试 2：HOST-CHS 得分为 94，尝试 3：HOST-CHS 得分为 91；P=.34），但在尝试 4 中提高了 79%（尝试 3：HOST-CHS 得分为 91，尝试 4：HOST-CHS 得分为 99；P=.004），与之前的表现相匹配。
每月的 HOST 课程成功地纳入了心胸外科医生的培训课程中，使用客观评估来衡量技术表现。受训者在所有评估的手术中都有所提高，并在延迟后重新评估时保留了他们的技能，这突出了其在心胸外科培训中的价值。
