Eber Jackson, Peterson Andrew C
University of Tennessee Health Science Center College of Medicine, Memphis, TN, United States.
Duke University Medical Center, Department of Surgery, Division of Urology, Durham, NC, United States.
Front Surg. 2022 Oct 20;9:997324. doi: 10.3389/fsurg.2022.997324. eCollection 2022.
It is increasingly important to identify and eliminate inefficiencies in resident education. We hypothesize that slower performance of specific operative steps in laparoscopic nephrectomy accounts for much of the slower operative speed observed in junior residents vs. their senior colleagues. Therefore, we sought to evaluate the by-step time-differential between experienced senior residents and their junior colleagues in a live-tissue simulation.
Residents participated in our swine model surgical simulation of laparoscopic radical and partial nephrectomy (LRNx and LPNx). PGY5 and 6 residents were considered senior; junior residents were PGY3 and 4. We defined discrete surgical steps. Residents' post-graduate training levels were tracked and time-to-completion of each operative step was recorded.
Seven live-tissue simulations sessions took place, with 12 residents conducting 22 operations (12 LRNx, 10 LPNx). On average, each resident operated in 2 simulation sessions (range 1-4). The average time required by senior residents for LPNx was 152 min; junior residents required 173 min ( = 0.35). When considering the operative steps, juniors required nearly twice as much time to achieve hilar control (42 min vs. 23 min, = 0.03). Significant differences in performance time were not seen in the other steps.
The performance differential between senior and junior residents conducting nephrectomies was most evident during hilar dissection. Our study suggests that specific efforts should be focused on teaching junior residents the skills required for this step early in their training.
识别并消除住院医师培训中的低效环节变得越来越重要。我们假设，腹腔镜肾切除术特定手术步骤的操作速度较慢是导致初级住院医师与高级同事相比手术速度较慢的主要原因。因此，我们试图在活体组织模拟中评估经验丰富的高级住院医师与其初级同事在逐个步骤上的时间差异。
住院医师参与了我们对腹腔镜根治性和部分肾切除术（LRNx和LPNx）的猪模型手术模拟。PGY5和6级住院医师被视为高级住院医师；初级住院医师为PGY3和4级。我们定义了离散的手术步骤。记录住院医师的研究生培训水平以及每个手术步骤的完成时间。
共进行了7次活体组织模拟手术，12名住院医师进行了22台手术（12台LRNx，10台LPNx）。平均而言，每位住院医师参与了2次模拟手术（范围为1 - 4次）。高级住院医师进行LPNx的平均时间为152分钟；初级住院医师需要173分钟（P = 0.35）。在考虑手术步骤时，初级住院医师实现肾门控制所需的时间几乎是高级住院医师的两倍（42分钟对23分钟，P = 0.03）。在其他步骤中未观察到操作时间的显著差异。
进行肾切除术的高级和初级住院医师之间的操作差异在肾门解剖过程中最为明显。我们的研究表明，应特别致力于在初级住院医师培训早期教授他们这一步骤所需的技能。
