ICube CNRS UMR7357, Strasbourg University, 2-4 rue Boussingault, Strasbourg, 67000, France.
Department of Hand Surgery, Strasbourg University Hospitals, FMTS, 1 avenue Molière, Strasbourg, 67200, France.
Int Orthop. 2022 Aug;46(8):1821-1829. doi: 10.1007/s00264-022-05464-4. Epub 2022 Jun 7.
BACKGROUND: Surgical teaching is most often carried out in the operating theatre through mentorship, and the performance of surgical procedures is rarely measured. The objective of this article is to compare the progression in learning curves of junior surgeons trained in the anterior plating technique for the distal radius on a nonbiological model according to three different methods. METHODS: The materials comprised 12 junior surgeons of level 1 or 2 (as per Tang and Giddins) divided into three groups: control (G1), naive practice (G2), and deliberate practice (G3). The three groups watched a demonstration video of a level 5 expert. The four G1 surgeons (two level 1 and two level 2) saw the video only once, and each inserted five plates. The four G2 surgeons (two level 1 and two level 2) inserted five plates and watched the video before each time. The four G3 surgeons (two level 1 and two level 2) saw the video before the first plate insertion. Before posing the subsequent four plates, the four G3 surgeons watched their own video, and the expert indicated their errors and how to avoid them next time. A 12-criteria OSATS defined on the basis of the 60 videos, each graded from one (min.) to five (max.), was used to measure the objective surgical performance per plating (min. 12; max. 60) and per series of five plate fixations (min. 60, max. 300). RESULTS: The total average objective performance of G1 was 44.73, of G2 was 50.57 and of G3 was 54.35. Change in objective performance was better for G3 (13.25) than G2 (5) or G1 (3.75). For all groups, the progression in objective performance was better amongst level 1 surgeons (9) than level 2 surgeons (5.6). CONCLUSION: Surgical teaching is based on mentorship and experience. However, since "see one, practice many, do one" has started to replace "see one, do one, teach one", learning techniques have increasingly relied on procedure simulators. Against this background, few studies have looked at measuring the performance of surgical procedures and improved learning curves. Our results appear to suggest that deliberate practice, when used in addition to mentorship, is the best option for shortening the growth phase of the learning curve and improving performance. Deliberate practice is a learning technique for surgical procedures that is complementary to mentorship and experience, which allows the growth phase of the learning curve to be shortened and the objective performance of junior surgeons to be improved.
背景:外科教学通常通过师徒制在手术室进行,很少对手术过程的表现进行衡量。本文的目的是比较三种不同方法培训的初级外科医生在非生物模型上学习桡骨远端钢板固定技术的学习曲线进展。
方法:研究材料包括 12 名初级外科医生(根据 Tang 和 Giddins 的标准为 1 级或 2 级),分为三组:对照组(G1)、盲目实践组(G2)和刻意练习组(G3)。三组均观看了 1 名 5 级专家的示范视频。G1 组的 4 名外科医生(2 名 1 级和 2 名 2 级)仅观看了 1 次视频,每人插入 5 块钢板。G2 组的 4 名外科医生(2 名 1 级和 2 名 2 级)插入 5 块钢板并在每次操作前观看视频。G3 组的 4 名外科医生(2 名 1 级和 2 名 2 级)在第一次插入钢板前观看了视频。在放置后续的 4 块钢板之前,G3 组的 4 名外科医生观看了自己的视频,专家指出了他们的错误,并下次如何避免这些错误。根据 60 个视频制定了一个 12 项的 OSATS 评分标准,每项评分从 1(最低)到 5(最高),用于测量每个钢板固定术的客观手术表现(最低 12,最高 60)和每个系列的五个钢板固定术的表现(最低 60,最高 300)。
结果:G1 的总平均客观表现为 44.73,G2 为 50.57,G3 为 54.35。与 G2(5)或 G1(3.75)相比,G3(13.25)的客观表现变化更好。对于所有组,1 级外科医生(9)的客观表现进展优于 2 级外科医生(5.6)。
结论:外科教学基于师徒制和经验。然而,自从“见一次,做多次,教一次”开始取代“见一次,做一次,教一次”后,学习技术越来越依赖于手术模拟器。在这种背景下,很少有研究关注测量手术过程的表现和提高学习曲线。我们的结果似乎表明,在师徒制的基础上,刻意练习是缩短学习曲线增长阶段和提高表现的最佳选择。刻意练习是一种补充师徒制和经验的手术学习技术,可以缩短学习曲线的增长阶段,提高初级外科医生的客观表现。
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