Su Peizhu, Zhu Zhengrong, He Jiawei, He Rong, Feng Huahai, Du Pu, Lönn Lars, Konge Lars, Yin Fang
Department of Gastroenterology, The First People's Hospital of Foshan, Foshan, Guangdong, China; Guangdong Academy for Medical Simulation (GAMS), Guangzhou, China.
Department of Vascular and Thyroid Surgery, The First People's Hospital of Foshan, Foshan, Guangdong, China.
Ann Vasc Surg. 2023 Feb;89:302-311. doi: 10.1016/j.avsg.2022.10.003. Epub 2022 Nov 9.
To explore whether simulation-based endovascular training with focus on radiation safety could improve correct behavior without jeopardizing the learning of procedural skills.
Twenty-four residents without previous endovascular experience completed 10 clinical scenarios on a virtual-reality endovascular simulator with software for peripheral endovascular interventions. Participants were randomized to receive feedback (n = 12) or not (n = 12) on radiation protection (RP) performance after each case. Expert assessments were done at the first, second, fourth, seventh, and 10th case on RP and endovascular skills (ES). Automatic simulator metrics on procedure time, contrast dose, handling errors, and estimated radiation exposure to patient and operator were registered. Outcome metrics were analyzed by two-way mixed analysis of variance pairwise comparisons with independent t-tests. Correlations were explored using Pearson's r for internal consistency reliability.
The RP performance was similar in both groups at their first attempt (P = 0.61), but the feedback group significantly outperformed the control group over time (P < 0.001 for all comparisons). The feedback group was however slower to learn the ES at start (P = 0.047 at second performance), but after 7 attempts no difference was shown (P = 0.59). The feedback group used more time (19.5 vs. 15.3 min; P = 0.007) but less contrast (60 vs. 100 mL; P < 0.001). The number of errors was the same in both groups, but all metrics regarding radiation exposure favored the feedback group (P-values from 0.001 to 0.008).
Simulation-based training (SBT) is effective to acquire basic endovascular intervention skills and concurrently learn RP behavior when feedback on radiation culture is provided.
探讨以辐射安全为重点的基于模拟的血管内培训能否在不影响程序技能学习的情况下改善正确行为。
24名此前无血管内经验的住院医师在具有外周血管内介入软件的虚拟现实血管内模拟器上完成10个临床场景。参与者被随机分为两组，每组12人，一组在每个病例后接受关于辐射防护（RP）表现的反馈，另一组不接受反馈。在第1、2、4、7和10个病例时由专家对RP和血管内技能（ES）进行评估。记录模拟器上关于手术时间、造影剂剂量、操作失误以及对患者和操作者估计辐射暴露的自动指标。通过双向混合方差分析和独立t检验进行成对比较来分析结果指标。使用Pearson相关系数r探索内部一致性可靠性的相关性。
两组首次尝试时的RP表现相似（P = 0.61），但随着时间推移，反馈组明显优于对照组（所有比较P < 0.001）。然而，反馈组开始学习ES时较慢（第二次操作时P = 0.047），但7次尝试后无差异（P = 0.59）。反馈组使用时间更多（19.5对15.3分钟；P = 0.007）但造影剂用量更少（60对100毫升；P < 0.001）。两组失误次数相同，但所有关于辐射暴露的指标都有利于反馈组（P值从0.001到0.008）。
当提供关于辐射文化的反馈时，基于模拟的培训（SBT）对于获得基本的血管内介入技能并同时学习RP行为是有效的。
