1Department of Neurosurgery, Kantonsspital St. Gallen; and.
2Ostschweizer Schulungs- und Trainingszentrum, Kantonsspital St. Gallen, Switzerland.
Neurosurg Focus. 2022 Aug;53(2):E13. doi: 10.3171/2022.5.FOCUS22193.
Restrictions on working time and healthcare expenditures, as well as increasing subspecialization with caseload requirements per surgeon and increased quality-of-care expectations, provide limited opportunities for surgical residents to be trained in the operating room. Yet, surgical training requires goal-oriented and focused practice. As a result, training simulators are increasingly utilized. The authors designed a two-step blended course consisting of a personalized adaptive electronic learning (e-learning) module followed by simulator training. This paper reports on course development and the evaluation by the first participants.
Adaptive e-learning was curated by learning engineers based on theoretical information provided by clinicians (subject matter experts). A lumbar spine model for image-guided spinal injections was used for the simulator training. Residents were assigned to the e-learning module first; after its completion, they participated in the simulator training. Performance data were recorded for each participant's e-learning module, which was necessary to personalize the learning experience to each individual's knowledge and needs. Simulator training was organized in small groups with a 1-to-4 instructor-to-participant ratio. Structured assessments were undertaken, adapted from the Student Evaluation of Educational Quality.
The adaptive e-learning module was curated, reviewed, and approved within 10 weeks. Eight participants have taken the course to date. The overall rating of the course is very good (4.8/5). Adaptive e-learning is well received compared with other e-learning types (8/10), but scores lower regarding usefulness, efficiency, and fun compared with the simulator training, despite improved conscious competency (32.6% ± 15.1%) and decreased subconscious incompetency (22.8% ± 10.2%). The subjective skill level improved by 20%. Asked about the estimated impact of the course, participants indicated that they had either learned something new that they plan to use in their practice (71.4%) or felt reassured in their practice (28.6%).
The development of a blended training course combining adaptive e-learning and simulator training in a rapid manner is feasible and leads to improved skills. Simulator training is rated more valuable by surgical trainees than theoretical e-learning; the impact of this type of training on patient care needs to be further investigated.
工作时间和医疗支出的限制，以及每例手术对外科医生的工作量要求和对医疗质量期望的增加导致外科住院医师在手术室接受培训的机会有限。然而，外科培训需要有明确目标和重点的实践。因此，培训模拟器越来越多地被使用。作者设计了一个由两部分组成的混合课程，包括个性化自适应电子学习（e-learning）模块，然后是模拟器培训。本文报告了课程的开发情况以及首批参与者的评估结果。
自适应电子学习是由学习工程师根据临床医生（主题专家）提供的理论信息来策划的。用于图像引导脊柱注射的腰椎模型被用于模拟器培训。住院医师首先被分配到电子学习模块；完成后，他们参加模拟器培训。为每位参与者的电子学习模块记录表现数据，这对于根据每个人的知识和需求使学习体验个性化是必要的。模拟器培训以 1 对 4 的指导员与参与者的比例分组进行。采用结构化评估方法，改编自学生教育质量评估。
自适应电子学习模块在 10 周内策划、审查和批准。迄今为止，已有 8 名参与者参加了该课程。该课程的总体评价非常好（4.8/5）。与其他电子学习类型相比，自适应电子学习受到好评（8/10），但在有用性、效率和趣味性方面得分较低，尽管有意识的能力明显提高（32.6%±15.1%），潜意识的无能感明显降低（22.8%±10.2%）。主观技能水平提高了 20%。当被问及该课程的估计影响时，参与者表示他们已经学到了一些新的东西，计划在实践中使用（71.4%），或者在实践中感到安心（28.6%）。
快速开发结合自适应电子学习和模拟器培训的混合培训课程是可行的，并能提高技能。外科住院医师对模拟器培训的评价比理论电子学习更有价值；这种培训对患者护理的影响需要进一步调查。
