Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts; Boston Children's Hospital Immersive Design Systems, Boston, Massachusetts; Harvard Medical School, Boston, Massachusetts.
Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, Massachusetts.
J Surg Educ. 2023 Dec;80(12):1859-1867. doi: 10.1016/j.jsurg.2023.08.010. Epub 2023 Sep 9.
High-fidelity simulation has a growing role in plastic surgical education. This study tests the hypothesis that cleft lip repair simulation followed by structured debriefing improves performance and self-confidence and that gains are maintained.
Prospective, single-blinded interventional study with repeated measures. Trainees performed cleft lip repair on a high-fidelity simulator followed by debriefing, immediately completed a second repair, and returned 3 months later for a third session. Anonymized simulation videos were rated using the modified Objective Structured Assessment of Technical Skills (OSATS) and the Unilateral Cleft Lip Repair competency assessment tool (UCLR). Self-assessed cleft lip knowledge/confidence and procedural self-confidence were surveyed after each simulation.
Boston Children's Hospital, a tertiary care academic hospital in Boston, MA, USA.
All trainees rotating through the study setting were eligible. Twenty-six participated; 21 returned for follow-up.
Significant improvements (p < 0.05) occurred between the first and second simulations for OSATS, UCLR, and procedural self-confidence. Significant improvement occurred between the second and third simulations cleft lip knowledge/confidence. Compared to the first simulation, improvements were maintained at the third simulation for all variables. Training level moderately correlated with score for UCLR for the first simulation (r = 0.55, p < 0.01), deteriorated somewhat with the second (r = 0.35, p = 0.08), and no longer corelated by the third (r = 0.02, p = 0.92).
Objective performance and subjective self-assessed knowledge and confidence improve with high-fidelity simulation plus structured debriefing and improvement is maintained. Differences in procedure-specific performance seen with increasing training level are reduced with simulation, suggesting it may accelerate knowledge and skill acquisition.
高保真模拟在整形外科学教育中扮演着越来越重要的角色。本研究检验了以下假设，即唇裂修复模拟加结构讨论能提高表现和自信心，并能保持收益。
前瞻性、单盲、重复测量的干预研究。学员在高保真模拟器上进行唇裂修复，然后进行讨论，立即完成第二次修复，并在 3 个月后返回进行第三次修复。使用改良的客观结构化评估技术（OSATS）和单侧唇裂修复能力评估工具（UCLR）对匿名模拟视频进行评分。每次模拟后，学员对唇裂知识/信心和手术过程自信心进行自我评估。
美国马萨诸塞州波士顿的波士顿儿童医院，一家三级护理学术医院。
所有在研究地点轮转的学员都有资格参加。共有 26 人参加，21 人返回进行随访。
在 OSATS、UCLR 和手术过程自信心方面，第一次和第二次模拟之间存在显著差异（p < 0.05）。在第二次和第三次模拟之间，唇裂知识/信心有显著提高。与第一次模拟相比，所有变量在第三次模拟中都保持了改善。与第一次模拟相比，UCLR 的评分与训练水平呈中度相关（r = 0.55，p < 0.01），在第二次模拟时略有下降（r = 0.35，p = 0.08），而在第三次模拟时不再相关（r = 0.02，p = 0.92）。
高保真模拟加结构讨论可提高客观表现和主观自我评估的知识和信心，且改善效果得以维持。随着训练水平的提高，手术过程特定表现的差异通过模拟减少，这表明模拟可能会加速知识和技能的获取。
