Jacobsen Mads Emil, Gustafsson Amandus, Jørgensen Per Gorm, Park Yoon Soo, Konge Lars
Copenhagen Academy for Medical Education and Simulation, Copenhagen, Denmark.
Orthopedic Department, Slagelse Hospital, Region Zealand, Denmark.
Orthop J Sports Med. 2021 Feb 23;9(2):2325967120985129. doi: 10.1177/2325967120985129. eCollection 2021 Feb.
Simulator-assisted arthroscopy education traditionally consists of initial training of basic psychomotor skills before advancing to more complex procedural tasks.
To explore and compare the effects of basic psychomotor skills training versus procedural skills training on novice surgeons' subsequent simulated knee arthroscopy performance.
Controlled laboratory study.
Overall, 22 novice orthopaedic surgeons and 11 experienced arthroscopic surgeons participated in this study, conducted from September 2015 to January 2017. Novices received a standardized introductory lesson on knee arthroscopy before being randomized into a basic skills training group or a procedural skills training group. Each group performed 2 sessions on a computer-assisted knee arthroscopy simulator: The basic skills training group completed 1 session consisting of basic psychomotor skills modules and 1 session of procedural modules (diagnostic knee arthroscopy and meniscal resection), whereas the procedural skills training group completed 2 sessions of procedural modules. Performance of the novices was compared with that of the experienced surgeons to explore evidence of validity for the basic psychomotor training skills modules and the procedural modules. The effect of prior basic psychomotor skills training and procedural skills training was explored by comparing pre- and posttraining performances of the randomized groups using a mixed-effects regression model.
Validity evidence was found for the procedural modules, as test results were reliable and experienced surgeons significantly outperformed novices. We found no evidence of validity for the basic psychomotor skills modules, as test scores were unreliable and there was no difference in performance between the experienced surgeons and novices. We found no statistical effect of basic psychomotor skills training as compared with no training ( = .49). We found a statistically significant effect of prior procedural skills training ( < .001) and a significantly larger effect of procedural skills training as compared with basic psychomotor skills training ( = .019).
Procedural skills training was significantly more effective than basic psychomotor skills training regarding improved performance in diagnostic knee arthroscopy and meniscal resection on a knee arthroscopy simulator. Furthermore, the basic psychomotor skills modules lacked validity evidence.
On the basis of these results, we suggest that future competency-based curricula focus their training on full knee arthroscopy procedures. This could improve future education programs.
传统上，模拟器辅助关节镜手术教育包括在推进到更复杂的手术任务之前，先进行基本心理运动技能的初步培训。
探讨并比较基本心理运动技能训练与手术技能训练对新手外科医生随后模拟膝关节镜手术表现的影响。
对照实验室研究。
2015年9月至2017年1月，共有22名骨科新手外科医生和11名经验丰富的关节镜外科医生参与了本研究。新手在接受膝关节镜手术的标准化入门课程后，被随机分为基本技能训练组或手术技能训练组。每组在计算机辅助膝关节镜手术模拟器上进行2次训练：基本技能训练组完成1次由基本心理运动技能模块组成的训练和1次手术模块训练（诊断性膝关节镜检查和半月板切除术），而手术技能训练组完成2次手术模块训练。将新手的表现与经验丰富的外科医生的表现进行比较，以探究基本心理运动训练技能模块和手术模块的有效性证据。通过使用混合效应回归模型比较随机分组的训练前和训练后的表现，探究先前基本心理运动技能训练和手术技能训练的效果。
发现手术模块具有有效性证据，因为测试结果可靠，且经验丰富的外科医生表现明显优于新手。未发现基本心理运动技能模块具有有效性证据，因为测试分数不可靠，且经验丰富的外科医生和新手在表现上没有差异。与未训练相比，未发现基本心理运动技能训练有统计学效应（P = 0.49）。发现先前手术技能训练有统计学显著效应（P < 0.001），且与基本心理运动技能训练相比，手术技能训练的效应显著更大（P = 0.019）。
在膝关节镜手术模拟器上，对于改善诊断性膝关节镜检查和半月板切除术的表现，手术技能训练比基本心理运动技能训练显著更有效。此外，基本心理运动技能模块缺乏有效性证据。
基于这些结果，我们建议未来基于能力的课程将训练重点放在全膝关节镜手术程序上。这可能会改善未来的教育项目。
