基于模拟的青光眼手术教育与单纯传统培训的比较：青光眼模拟手术（GLASS）试验。一项在肯尼亚、南非、坦桑尼亚、乌干达和津巴布韦进行的多中心、多国、随机对照、研究者设盲的教育干预疗效试验。
Simulation-based surgical education for glaucoma versus conventional training alone: the GLAucoma Simulated Surgery (GLASS) trial. A multicentre, multicountry, randomised controlled, investigator-masked educational intervention efficacy trial in Kenya, South Africa, Tanzania, Uganda and Zimbabwe.
作者信息
Dean William H, Buchan John, Gichuhi Stephen, Philippin Heiko, Arunga Simon, Mukome Agrippa, Admassu Fisseha, Lewis Karinya, Makupa William, Otiti Juliet, Kim Min J, Macleod David, Cook Colin, Burton Matthew J
机构信息
International Centre for Eye Health, Department of Clinical Research, London School of Hygiene and Tropical Medicine, London, UK
Ophthalmology, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa.
出版信息
Br J Ophthalmol. 2022 Jun;106(6):863-869. doi: 10.1136/bjophthalmol-2020-318049. Epub 2021 Jan 25.
BACKGROUND/AIM: Glaucoma accounts for 8% of global blindness and surgery remains an important treatment. We aimed to determine the impact of adding simulation-based surgical education for glaucoma.
METHODS
We designed a randomised controlled, parallel-group trial. Those assessing outcomes were masked to group assignment. Fifty-one trainee ophthalmologists from six university training institutions in sub-Saharan Africa were enrolled by inclusion criteria of having performed no surgical trabeculectomies and were randomised. Those randomised to the control group received no placebo intervention, but received the training intervention after the initial 12-month follow-up period. The intervention was an intense simulation-based surgical training course over 1 week. The primary outcome measure was overall simulation surgical competency at 3 months.
RESULTS
Twenty-five were assigned to the intervention group and 26 to the control group, with 2 dropouts from the intervention group. Forty-nine were included in the final intention-to-treat analysis. Surgical competence at baseline was comparable between the arms. This increased to 30.4 (76.1%) and 9.8 (24.4%) for the intervention and the control group, respectively, 3 months after the training intervention for the intervention group, a difference of 20.6 points (95% CI 18.3 to 22.9, p<0.001). At 1 year, the mean surgical competency score of the intervention arm participants was 28.6 (71.5%), compared with 11.6 (29.0%) for the control (difference 17.0, 95% CI 14.8 to 19.4, p<0.001).
CONCLUSION
These results support the pursuit of financial, advocacy and research investments to establish simulation surgery training units and courses including instruction, feedback, deliberate practice and reflection with outcome measurement to enable trainee glaucoma surgeons to engage in intense simulation training for glaucoma surgery.
TRIAL REGISTRATION NUMBER
PACTR201803002159198.
背景/目的：青光眼导致全球8%的失明，手术仍是重要的治疗方法。我们旨在确定增加基于模拟的青光眼手术教育的影响。
方法
我们设计了一项随机对照平行组试验。评估结果的人员对分组情况不知情。来自撒哈拉以南非洲六所大学培训机构的51名实习眼科医生符合未进行过小梁切除术的纳入标准并被随机分组。随机分配到对照组的人员未接受安慰剂干预，但在最初的12个月随访期后接受培训干预。干预措施是为期1周的强化模拟手术培训课程。主要结局指标是3个月时的总体模拟手术能力。
结果
25人被分配到干预组，26人被分配到对照组，干预组有2人退出。49人纳入最终的意向性分析。两组基线时的手术能力相当。干预组在培训干预3个月后，手术能力分别提高到30.4（76.1%）和9.8（24.4%），对照组为9.8（24.4%），相差20.6分（95%CI 18.3至22.9，p<0.001）。1年后，干预组参与者的平均手术能力评分为28.6（71.5%），对照组为11.6（29.0%）（差值17.0，95%CI 14.8至19.4，p<0.001）。
结论
这些结果支持寻求资金、宣传和研究投资，以建立模拟手术培训单位和课程，包括指导、反馈、刻意练习和反思以及结果测量，使青光眼外科实习医生能够参与青光眼手术的强化模拟培训。
试验注册号
PACTR201803002159198。
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