Department of Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston, IL; Department of Surgery, University of Chicago, Chicago, IL.
Department of Minimally Invasive Surgery, NorthShore University HealthSystem, Evanston, IL; Department of Surgery, University of Chicago, Chicago, IL.
Surgery. 2023 Mar;173(3):702-709. doi: 10.1016/j.surg.2022.06.047. Epub 2022 Oct 27.
As flexible endoscopy is increasingly adopted as a minimally invasive approach to surgical challenges, an efficient curriculum is needed to train surgeons in therapeutic endoscopy. We developed a simulation-based approach to teaching endoscopic management of gastrointestinal hemorrhage as part of a modular curriculum, complete with task performance pre- and post-testing.
Two sessions of our advanced flexible endoscopy course were taught using ex vivo porcine models to simulate active gastrointestinal hemorrhage and allow for training in hands-on endoscopic management. The module is composed of hands-on pretesting, didactics, mentored practice sessions, and postcourse assessments. Pre- and postcourse tests and surveys evaluated knowledge, confidence, and performance of participants and results were analyzed using the paired t test.
Sixteen practicing surgeons participated in the course. After course completion, overall knowledge-based assessments improved from 3.4 (±1.9) to 5.8 (±2.0) (P < .001). Although participants with glove sizes >7.0 and ≥2 years in practice had higher pretest evaluator scores (P = .045 and P = .020), all participants demonstrated overall improvement in endoscopic management of hemorrhage, with postcourse evaluator score increases from 20.9 (±1.6) to 23.6 (±2.0) (P = .001) and specific improvements in identification of target bleeding (P = .015), endoscopic clip setup (P < .001), and clip deployment (P = .002). Surveys also found increased confidence in competency after curriculum completion, 11.6 (±3.4)-23.0 (±5.5) (P < .001).
Our simulation-based approach to teaching the endoscopic management of gastrointestinal bleeding emphasizes hands-on pretesting and provides an effective training model to improve the knowledge, confidence, and technical performance of practicing surgeons.
随着内镜技术作为一种微创手段被越来越多地应用于外科挑战，我们需要开发一种高效的培训课程，以培养外科医生的治疗内镜技术。我们开发了一种基于模拟的方法，来教授内镜治疗胃肠道出血，作为模块化课程的一部分，包括任务表现的前测和后测。
我们使用离体猪模型进行了两次高级内镜课程，以模拟活动性胃肠道出血，并进行内镜管理的实践培训。该模块由实践前测、讲座、导师指导的实践环节和课后评估组成。课前和课后测试和调查评估了参与者的知识、信心和表现，使用配对 t 检验分析结果。
16 名执业外科医生参加了该课程。课程结束后，基于知识的评估总体上从 3.4（±1.9）提高到 5.8（±2.0）（P <.001）。尽管手套尺寸>7.0 和实践经验≥2 年的参与者的前测评估分数更高（P =.045 和 P =.020），但所有参与者在出血的内镜管理方面都表现出了总体的改善，课后评估分数从 20.9（±1.6）提高到 23.6（±2.0）（P =.001），并且在识别目标出血（P =.015）、内镜夹设置（P <.001）和夹放置（P =.002）方面都有具体的提高。调查还发现，课程结束后，参与者对自己的能力更有信心，从 11.6（±3.4）提高到 23.0（±5.5）（P <.001）。
我们基于模拟的内镜治疗胃肠道出血教学方法强调实践前测，并为提高执业外科医生的知识、信心和技术表现提供了有效的培训模式。
