Department of Surgery, Kyorin University, Tokyo, Japan.
Department of Surgery, NorthShore University HealthSystem, 2650 Ridge Ave, GCSI rmB665, Evanston, IL, 60201, USA.
Surg Endosc. 2022 Dec;36(12):9273-9280. doi: 10.1007/s00464-022-09152-7. Epub 2022 Mar 21.
BACKGROUND: Simulation is an important tool in surgical training. However, the transferability of skills obtained in the simulation setting to the operating room (OR) is uncertain. This study explores the association between resident simulation performance and OR performance in a laparoscopic cholecystectomy (LC) simulation module. METHODS: A simulation module focused on LC utilizing a virtual reality simulator was completed by general surgery residents. Simulation performance was evaluated using the validated Global Operative Assessment of Laparoscopic Skills (GOALS) and Objective Structured Assessment of Technical Skills (OSATS), as well as a LC-specific simulation assessment form (LC-SIM). Resident subsequent OR performances of LC were measured by the Surgical Training and Assessment Tool (STAT), an online mobile-based evaluation completed by attending surgeons. RESULTS: Twenty-one residents who completed the simulation module and also with STAT data on LC from 2016 to 2020 were included. Higher scores on incision/port placement on LC-SIM is associated with better tissue handling (coefficient 0.20, p = 0.048) and better time & economy of motion on STAT (coefficient 0.22, p = 0.037). However, higher scores on time and motion on OSATS are associated with worse tissue handling (- 0.28, p = 0.046), worse time & economy of motion (- 0.37, p = 0.009), and worse overall grade (- 0.21, p = 0.044). Higher scores on overall performance on OSATS is associated with worse time & economy of motion (- 0.80, p = 0.008). Higher scores on depth perception on GOALS are associated with worse tissue handling (- 0.28, p = 0.044). CONCLUSION: We found significant positive and negative associations between resident simulation performance and OR performance, particularly in tissue handling and economy of motion. This could suggest that simulation performance does not reliably predict OR performance. However, this could highlight the concept of excessive caution in the real OR environment and longer operative time which could be interpreted as worse time and economy of motion by the attending surgeons.
背景：模拟是外科培训的重要工具。然而，在模拟环境中获得的技能转移到手术室（OR）的能力尚不确定。本研究探讨了腹腔镜胆囊切除术（LC）模拟模块中住院医师模拟表现与 OR 表现之间的关系。
方法：普通外科住院医师使用虚拟现实模拟器完成了一个专注于 LC 的模拟模块。使用经过验证的全球腹腔镜技能操作评估（GOALS）和客观结构化手术技能评估（OSATS），以及特定于 LC 的模拟评估表（LC-SIM）来评估模拟表现。住院医师随后在 2016 年至 2020 年期间通过由主治外科医生完成的在线移动评估工具（STAT）来评估 LC 的 OR 表现。
结果：共有 21 名完成模拟模块且在 LC 方面具有 STAT 数据的住院医师被纳入研究。LC-SIM 中切口/端口放置评分较高与组织处理更好（系数 0.20，p=0.048）和 STAT 中时间和运动经济更好相关（系数 0.22，p=0.037）。然而，OSATS 中时间和运动评分较高与组织处理更差（-0.28，p=0.046）、时间和运动经济更差（-0.37，p=0.009）和整体评分更差（-0.21，p=0.044）相关。OSATS 中整体表现评分较高与时间和运动经济更差相关（-0.80，p=0.008）。GOALS 中深度知觉评分较高与组织处理更差相关（-0.28，p=0.044）。
结论：我们发现住院医师模拟表现与 OR 表现之间存在显著的正相关和负相关，特别是在组织处理和运动经济方面。这可能表明模拟表现不能可靠地预测 OR 表现。然而，这可能突出了在真实 OR 环境中过度谨慎的概念和较长的手术时间，这可能被主治外科医生解释为时间和运动经济更差。
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