Magalski Gabrielle R, Obermair Andreas, Hanna George B, Graves Nicholas, Coleman Mark G, Horsham Caitlin, Sanjida Saira, Silva Carina V, Rao Archana, Janda Monika
Centre for Clinical Research, The University of Queensland, Brisbane, Australia (Drs Magalski, Obermair and Rao).
Queensland Centre for Gynaecological Cancer, Royal Brisbane and Women's Hospital, Herston, Australia (Drs Obermair and Rao).
AJOG Glob Rep. 2023 Jul 1;3(3):100249. doi: 10.1016/j.xagr.2023.100249. eCollection 2023 Aug.
Advanced surgical techniques, such as total laparoscopic hysterectomy, are often challenging to acquire beyond fellowship training programs for practicing obstetrician-gynecologists. A lack of formative data currently exist for continuing medical education programs, limiting our understanding of how improvement in surgical skills and training programs occur.
This study aimed to investigate how practicing obstetrician-gynecologists acting as trainees experience a program that aims to teach them total laparoscopic hysterectomy, and to assess whether their surgical skills improve according to data from formative assessment tools and qualitative data from open-ended survey questions and in-depth interviews.
We report a process analysis of formative data collected during a pilot implementation trial of a surgical training program targeting practicing obstetrician-gynecologists. Eleven consultant obstetrician-gynecologists and 4 experienced surgical mentors participated in 4 hospitals in Queensland, Australia. Total laparoscopic hysterectomy was performed in 700 patients over the course of the study. A total laparoscopic hysterectomy surgical mentorship training program of 10 training days with up to 3 total laparoscopic hysterectomy procedures per day was performed. Both the obstetrician-gynecologists and the surgical mentor completed a formative assessment questionnaire analyzing the trainee's performance after each surgical procedure. Mentors were formatively assessed by the Structured Training Trainer Assessment Report (STTAR) and at the completion of the study by the mini-STTAR, a summative assessment of quality of mentorship. Obstetrician-gynecologists, mentors, hospital leaders, and surgical administrative staff participated in qualitative interviews about the training program.
Over time, there was a demonstrated improvement in trainee performance reported by both mentors and trainees in all competency assessment tool domains as the case number increased, with mentors consistently rating trainees' performance higher than the trainees themselves. Most trainees were satisfied with their mentor in all 31 areas during formative assessment, and at the end of the training, structure, attributes, and role modeling were all rated high (average score >4.5; range, 3.79-5.00), whereas training behavior was rated slightly lower at 4.1 (range, 3.79-4.45). Qualitative interviews demonstrated that the trainees found the training to be a beneficial, hands-on experience.
Formative assessment clearly documented improvement in surgical skills during a total laparoscopic hysterectomy training program for consultant obstetrician-gynecologists.
先进的外科技术，如全腹腔镜子宫切除术，对于执业妇产科医生而言，在完成专科培训项目之后往往难以掌握。目前继续医学教育项目缺乏形成性数据，这限制了我们对手术技能提升以及培训项目如何发挥作用的理解。
本研究旨在调查执业妇产科医生作为学员参与旨在教授他们全腹腔镜子宫切除术的项目的体验，并根据形成性评估工具的数据以及开放式调查问卷和深度访谈的定性数据，评估他们的手术技能是否得到提高。
我们报告了一项针对执业妇产科医生的手术培训项目试点实施试验期间收集的形成性数据的过程分析。11名妇产科顾问医生和4名经验丰富的手术导师参与了澳大利亚昆士兰州的4家医院的项目。在研究过程中，对700例患者实施了全腹腔镜子宫切除术。开展了为期10天的全腹腔镜子宫切除术手术导师培训项目，每天最多进行3例全腹腔镜子宫切除术。妇产科医生和手术导师在每次手术后都完成了一份分析学员表现的形成性评估问卷。导师通过结构化培训培训师评估报告（STTAR）进行形成性评估，并在研究结束时通过迷你STTAR进行总结性评估，以评估导师指导质量。妇产科医生、导师、医院领导和手术管理人员参与了关于培训项目的定性访谈。
随着病例数的增加，导师和学员报告显示，随着时间推移，在所有能力评估工具领域，学员表现均有改善，导师对学员表现的评分始终高于学员自身。在形成性评估期间，大多数学员在所有31个方面对他们的导师感到满意，在培训结束时，结构、特质和榜样示范方面的评分均很高（平均分>4.5；范围为3.79 - 5.00），而培训行为的评分为4.1（范围为3.79 - 4.45），略低。定性访谈表明，学员们认为该培训是一次有益的实践体验。
形成性评估清楚地记录了在为妇产科顾问医生开展的全腹腔镜子宫切除术培训项目中，手术技能得到了提高。
