Colchester Hospital, Essex, UK.
St George's University of London Medical School, London, UK.
Ann R Coll Surg Engl. 2021 May;103(5):318-323. doi: 10.1308/rcsann.2020.7138. Epub 2021 Apr 14.
As surgical education has evolved, most curricula have favoured a competency-based approach over traditional apprenticeship models. Surgical simulation can be a useful aide in the training of both oncological and reconstructive breast surgery trainees. This review investigates the extent to which simulation of breast surgery procedures has been validated as a training tool.
A comprehensive literature search for studies evaluating the objective validity of breast surgery simulators was performed, using MEDLINE, EMBASE and the Cochrane Library databases. Studies assessing construct, concurrent or predictive validity were included, as well as those demonstrating skill acquisition.
The initial literature search returned 1,625 hits, with only five articles meeting the inclusion criteria. Simulators were designed to train procedures such as breast augmentation, lesion biopsy and excision. Of these, breast biopsy was the most simulated procedure (three studies). Two studies evaluated animal models, two evaluated synthetic models and one study assessed both a synthetic and animal model. Construct validity was confirmed in two studies, concurrent validity in one study and a learning curve demonstrated in another study. No association between experience and performance was seen in the remaining study. The quality of the evidence presented in each article was low due to numerous limitations. Despite the abundance of breast surgery simulators created for trainees, few have been objectively validated and they only cover a narrow range of breast procedures. Although early results are promising, further studies are required before routine use of simulators is considered in breast surgery curricula.
随着外科教育的发展，大多数课程都倾向于采用基于能力的方法，而不是传统的学徒模式。外科模拟可以成为肿瘤和重建乳房手术培训师培训的有用辅助工具。本综述调查了乳房手术模拟作为培训工具的验证程度。
使用 MEDLINE、EMBASE 和 Cochrane 图书馆数据库对评估乳房手术模拟器客观有效性的研究进行了全面的文献检索。纳入了评估构建、同期或预测有效性的研究，以及那些证明技能习得的研究。
最初的文献检索返回了 1625 个结果，只有 5 篇文章符合纳入标准。模拟器旨在培训乳房增大、病变活检和切除等手术。其中，乳房活检是模拟最多的手术（三项研究）。两项研究评估了动物模型，两项研究评估了合成模型，一项研究评估了合成模型和动物模型。两项研究证实了结构有效性，一项研究证实了同期有效性，另一项研究展示了学习曲线。在其余的研究中，没有看到经验与表现之间的关联。由于存在许多局限性，每篇文章中提出的证据质量都较低。尽管为学员创建了大量的乳房手术模拟器，但很少有经过客观验证的，而且它们只涵盖了乳房手术的狭窄范围。尽管早期结果很有希望，但在考虑将模拟器纳入乳房手术课程之前，还需要进一步的研究。
