Skjold-Odegaard Benedicte, Ersdal Hege Langli, Assmus Jörg, Nedrebo Bjorn Steinar Olden, Sjo Ole, Soreide Kjetil
Gastrointestinal Surgery, Haugesund Hospital, Haugesund, Norway.
Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
BMJ Simul Technol Enhanc Learn. 2021 Jun 2;7(6):517-523. doi: 10.1136/bmjstel-2020-000728. eCollection 2021.
Laparoscopic appendectomy is a common procedure in general surgery but is likely underused in structured and real-life teaching. This study describes the development, validation and evaluation of implementing a structured training programme for laparoscopic appendectomy.
A structured curriculum and simulation-based programme for trainees and trainers was developed. All general surgery trainees and trainers were involved in laparoscopic appendectomies. All trainees and trainers underwent the structured preprocedure training programme before real-life surgery evaluation. A standardised form evaluated eight technical steps (skills) of the procedure as well as an overall assessment, and nine elements of communication (feedback), and was used for bilateral evaluation by each trainee and trainer. A consecutive, observational cohort over a 12-month period was used to gauge real-life implementation.
During 277 eligible real-life appendectomies, structured evaluation was performed in 173 (62%) laparoscopic appendectomies, for which 165 forms were completed by 19 trainees. Construct validity was found satisfactory. Inter-rater reliability demonstrated good correlation between trainee and trainer. The trainees' and trainers' stepwise and overall assessments of technical skills had an overall good reliability (intraclass correlation coefficient of 0.88). The vast majority (92.2%) of the trainees either agreed or strongly agreed that the training met their expectations.
Structured training for general surgery residents can be implemented for laparoscopic appendectomy. Skills assessment by trainees and trainers indicated reliable self-assessment. Overall, the trainees were satisfied with the training, including the feedback from the trainers.
腹腔镜阑尾切除术是普通外科的常见手术，但在结构化和实际教学中可能未得到充分应用。本研究描述了腹腔镜阑尾切除术结构化培训计划的制定、验证和评估。
为学员和培训师制定了结构化课程和基于模拟的培训计划。所有普通外科住院医师和培训师都参与了腹腔镜阑尾切除术。所有学员和培训师在进行实际手术评估前都接受了结构化的术前培训计划。使用标准化表格评估该手术的八个技术步骤（技能）以及总体评估，以及沟通的九个要素（反馈），并由每位学员和培训师进行双向评估。采用连续观察队列，为期12个月，以评估实际实施情况。
在277例符合条件的实际阑尾切除术中，173例（62%）腹腔镜阑尾切除术进行了结构化评估，19名学员完成了165份表格。结构效度令人满意。评分者间信度表明学员和培训师之间具有良好的相关性。学员和培训师对技术技能的逐步和总体评估总体可靠性良好（组内相关系数为0.88）。绝大多数（92.2%）学员同意或强烈同意培训符合他们的期望。
可对普通外科住院医师实施腹腔镜阑尾切除术的结构化培训。学员和培训师的技能评估表明自我评估可靠。总体而言，学员对培训感到满意，包括培训师的反馈。
