Crouch Gareth, Wong Gerald, Hong Jonathan, Varey Alex, Haddad Roger, Wang Zane Zhanxiang, Wykes James, Koutalistras Nick, Clark Jonathan R, Solomon Michael, Bannon Paul, McBride Kate E, Ch'ng Sydney
Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Insitute of Academic Surgery at Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia.
ANZ J Surg. 2021 Jun;91(6):1110-1116. doi: 10.1111/ans.16721. Epub 2021 Mar 15.
Laboratory simulation is increasingly important for teaching microsurgical skills. Training microsurgeons of different specialties within the same simulation laboratory increases efficiency of resource use. For maximal benefit, simulations should be available for trainees to practice specialty-specific, higher-order skills. Selection of appropriate simulations requires knowledge of the efficacy and validity of the numerous described laboratory models. Here we present a systematic review of validated training models that may serve as useful adjuncts to achieving competency in specialty elements of microsurgery, and appraise the evidence behind them.
In setting up a multi-disciplinary microsurgery training course, we performed a systematic review according to preferred reporting items for systematic reviews and meta-analyses guidelines. EMBASE, MEDLINE, Cochrane and PubMed databases were searched for studies describing validated, microscope-based, specialty-specific simulations, and awarded a level of evidence and level of recommendation based on a modified Oxford Centre for Evidence-Based Medicine classification.
A total of 141 papers describing specialty-specific microsimulation models were identified, 49 of which included evidence of validation. Eleven were in the field of neurosurgery, 21 in otolaryngology/head and neck surgery, two in urology/gynaecology and 15 plastic and reconstructive surgery. These papers described synthetic models in 19 cases, cadaveric animals in 10 cases, live animals in 12 cases and human cadaveric material in 10 cases.
Numerous specialty-specific models for use in the microscope laboratory are available, but the quality of evidence for them is poor. Provision of models that span numerous specialties may encourage use of a microscope lab whilst still enabling more specific skills training over a 'one-size-fits-all' approach.
实验室模拟对于显微外科技能教学日益重要。在同一模拟实验室中培训不同专业的显微外科医生可提高资源利用效率。为了获得最大效益，应提供模拟训练供学员练习特定专业的高阶技能。选择合适的模拟训练需要了解众多已描述的实验室模型的有效性和效度。在此，我们对经过验证的训练模型进行系统综述，这些模型可能有助于在显微外科特定专业技能方面达到胜任水平，并评估其背后的证据。
在设立一门多学科显微外科培训课程时，我们根据系统综述和荟萃分析的首选报告项目指南进行了系统综述。检索了EMBASE、MEDLINE、Cochrane和PubMed数据库，以查找描述经过验证的、基于显微镜的、特定专业模拟训练的研究，并根据改良的牛津循证医学中心分类法授予证据等级和推荐等级。
共识别出141篇描述特定专业显微模拟模型的论文，其中49篇包含验证证据。11篇涉及神经外科领域，21篇涉及耳鼻喉科/头颈外科，2篇涉及泌尿外科/妇科，15篇涉及整形和重建外科。这些论文描述了19例合成模型、10例尸体动物模型、12例活体动物模型和10例人体尸体材料模型。
有许多适用于显微镜实验室的特定专业模型，但相关证据质量较差。提供涵盖多个专业的模型可能会鼓励使用显微镜实验室，同时仍能通过“一刀切”的方法进行更具针对性的技能培训。
