Ortiz Catalina, Belmar Francisca, Rebolledo Rolando, Vela Javier, Contreras Caterina, Inzunza Martin, Ramos Juan Pablo, Zinco Analía, Alseidi Adnan, Varas Julián, Jarufe Nicolás, Achurra Pablo
Experimental Surgery and Simulation Center, Department of Digestive Surgery. Pontificia Universidad Católica de Chile, Santiago, Chile.
Institute for Biomedical Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile.
J Surg Res. 2021 Dec;268:507-513. doi: 10.1016/j.jss.2021.06.069. Epub 2021 Aug 24.
Trauma is one of the main causes of death globally, and appropriate surgical care is crucial to impact mortality. However, resident-performed trauma cases have diminished in the last 10 years. Simulation-based tools have proven to be effective to evaluate practical skills in a variety of settings. However, there is a lack of evidence regarding proper validation of trauma surgery models.
The aim of this study was to evaluate under a contemporary validity framework, an objective structured clinical evaluation (OSCE) scenario for the assessment of basic and advanced surgical skills in trauma and emergency surgery.
An OSCE-type simulation assessment program was developed incorporating six stations representing basic and advanced surgical skills that are essential in trauma surgery. Each station was designed using ex-vivo animal tissue. The stations included basic knots and sutures, bowel resection and anastomosis, vascular end-to-end anastomosis, lung injury repair, cardiac injury repair, and laparoscopic suturing. Eight postgraduate year 2 (PY-2), eight recently graduated surgeons (RGS), and 3 experts were recruited, and their performance was blindly assessed by experts using the validated general rating scale OSATS (Objective Structured Assessment of Technical Skills) as well as the time taken to complete the procedure.
Significant differences were identified among groups. The average OSATS score was 82 for the PY2 group, 113 for the RGS group, and 147 for the experts (P < 0.01). The average procedural time to complete all the stations was 98 minutes for the PY2 group, 68 minutes for the RGS group, and 35 minutes for the expert surgeons (P < 0.01).
An OSCE scenario designed using ex-vivo tissue met 4 out of 5 criteria of the Messick validity framework: content, relation to other variables, response process and consequences of the test. The results show it is a valid strategy for the evaluation of practical skills in trauma surgery.
创伤是全球主要的死亡原因之一，适当的外科治疗对于降低死亡率至关重要。然而，住院医师实施的创伤病例在过去10年中有所减少。基于模拟的工具已被证明在各种环境中评估实践技能是有效的。然而，关于创伤手术模型的适当验证缺乏证据。
本研究的目的是在当代有效性框架下，评估一种客观结构化临床评估（OSCE）方案，用于评估创伤和急诊手术中的基本和高级外科技能。
开发了一个OSCE类型的模拟评估程序，包括六个代表创伤手术中基本和高级外科技能的站点。每个站点使用离体动物组织设计。这些站点包括基本打结和缝合、肠切除和吻合、血管端端吻合、肺损伤修复、心脏损伤修复和腹腔镜缝合。招募了8名二年级研究生（PY-2）、8名刚毕业的外科医生（RGS）和3名专家，专家使用经过验证的通用评分量表OSATS（客观结构化技术技能评估）以及完成手术所需的时间对他们的表现进行盲评。
各组之间存在显著差异。PY2组的平均OSATS评分为82分，RGS组为113分，专家组为147分（P<0.01）。PY2组完成所有站点的平均手术时间为98分钟，RGS组为68分钟，专家外科医生为35分钟（P<0.01）。
使用离体组织设计的OSCE方案符合梅西克有效性框架的5项标准中的4项：内容、与其他变量的关系、反应过程和测试结果。结果表明，它是评估创伤手术实践技能的有效策略。
