Lillemoe Heather A, Hanna David N, Baregamian Naira, Solórzano Carmen C, Terhune Kyla P, Geevarghese Sunil K, Kiernan Colleen M
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Surgical Oncology, The University of Texas at MD Anderson Cancer Center, Houston, TX.
Department of Surgery, Vanderbilt University Medical Center, Nashville, TN.
Surgery. 2023 Jan;173(1):84-92. doi: 10.1016/j.surg.2022.07.027. Epub 2022 Oct 7.
As surgical training shifts toward a competency-based paradigm, deliberate practice for procedures must be a point of focus. The purpose of this study was to assess the impact of an educational time-out intervention on educational experience and operative performance in endocrine surgery.
For 12 months, third-year general surgery residents used the educational time-out to establish an operative step of focus for thyroidectomy and parathyroidectomy procedures. Data were collected using the System for Improving and Measuring Procedural Learning application and post-rotation surveys. The Zwisch scale was used to classify supervision, with meaningful autonomy defined as passive help or supervision only.
Eight residents and 3 attending surgeons performed the educational time-out for a total of 211 operations (93% completion rate). At the end of each rotation, there was improvement in the frequency of goal setting. There was strong agreement (90%) that the intervention strengthened the educational experience. For most cases (52%), the residents were rated at active help. Residents performed a median of 3/6 thyroidectomy steps at meaningful autonomy and a median of 2/5 parathyroidectomy steps at meaningful autonomy. Review of the qualitative data revealed that optimal feedback was provided in 46% of cases.
The educational time-out strengthened educational experiences. Stepwise procedural data revealed the varying levels of supervision that exist within an operation. Broader implementation of this intervention could facilitate competency-based procedural education.
随着外科培训向基于能力的模式转变，手术操作的刻意练习必须成为重点。本研究的目的是评估教育暂停干预对内分泌外科教育体验和手术操作表现的影响。
在12个月的时间里，三年级普通外科住院医师利用教育暂停来确定甲状腺切除术和甲状旁腺切除术的一个重点手术步骤。使用改进和测量程序学习系统应用程序以及轮转后调查问卷收集数据。Zwisch量表用于对监督进行分类，有意义的自主定义为仅提供被动帮助或监督。
8名住院医师和3名主治外科医生进行了教育暂停，共进行了211台手术（完成率93%）。在每次轮转结束时，目标设定的频率有所提高。90%的人强烈认为该干预增强了教育体验。在大多数病例（52%）中，住院医师被评为主动帮助。住院医师在有意义的自主状态下进行甲状腺切除步骤的中位数为3/6，甲状旁腺切除步骤的中位数为2/5。对定性数据的审查显示，46%的病例提供了最佳反馈。
教育暂停增强了教育体验。逐步的程序数据揭示了手术中存在的不同监督水平。更广泛地实施这种干预可能有助于基于能力的程序教育。
