Centre for Clinical Research, Region Sörmland, Uppsala University, Eskilstuna, Sweden.
Division of Urology, CLINTEC, Karolinska Institutet, Stockholm, Sweden.
BMC Med Educ. 2023 Oct 10;23(1):749. doi: 10.1186/s12909-023-04719-x.
Studies have shown the clinical benefits of laparoscopic simulator training. Decreasing numbers of operations by surgical residents have further increased the need for surgical simulator training. However, many surgical simulators in Sweden are often insufficiently used or not used at all. Furthermore, large geographical distances make access to curriculum-based surgical simulator training at established simulator centres difficult. The aim of this study was to evaluate whether tele-mentoring (TM) could be well tolerated and improve basic laparoscopic surgical skills of medical students 900 km away from the teacher.
Twenty students completed an informed consent and a pre-experimental questionnaire. The students were randomized into two groups: (1) TM (N = 10), receiving instructor feedback via video-link and (2) control group (CG, N = 10) with lone practice. Initial warm-up occurred in the Simball Box simulator with one Rope Race task followed by five consecutive Rope Race and three Peg Picker tasks. Afterwards, all students completed a second questionnaire.
The whole group enjoyed the simulator training (prescore 73.3% versus postscore 89.2%, P < 0.0001). With TM, the simulator Rope Race overall score increased (prescore 30.8% versus postscore 43.4%; P = 0.004), and the distance that the laparoscopic instruments moved decreased by 40% (P = 0.015), indicating better precision, whereas in the CG it did not. In Peg Picker, the overall scores increased, whereas total time and distance of the instruments decreased in both groups, indicating better performance and precision.
Simulation training was highly appreciated overall. The TM group showed better overall performance with increased precision in what we believe to be the visuospatially more demanding Rope Race tasks compared to the CG. We suggest that surgical simulator tele-mentoring over long distances could be a viable way to both motivate and increase laparoscopic basic skills training in the future.
研究表明腹腔镜模拟器训练具有临床益处。由于外科住院医师的手术数量减少，对手术模拟器培训的需求进一步增加。然而，瑞典的许多外科模拟器通常使用不足或根本不使用。此外，由于地域辽阔，很难接触到在既定模拟器中心进行的基于课程的外科模拟器培训。本研究旨在评估远程指导（TM）是否可以被很好地接受，并提高远离教师 900 公里的医学生的基本腹腔镜外科技能。
20 名学生完成了知情同意书和预实验问卷。学生随机分为两组：（1）TM 组（N=10），通过视频链接接收指导教师的反馈；（2）对照组（CG，N=10），单独练习。最初在 Simball Box 模拟器中进行预热，完成一个绳索竞赛任务，然后连续完成五个绳索竞赛和三个插针任务。之后，所有学生完成第二个问卷。
整个小组都喜欢模拟器培训（预评分 73.3%，后评分 89.2%，P<0.0001）。通过 TM，模拟器绳索竞赛的总体得分增加（预评分 30.8%，后评分 43.4%；P=0.004），腹腔镜器械的移动距离减少了 40%（P=0.015），表明精度提高，而 CG 组则没有。在插针任务中，两组的总体得分均有所提高，而器械的总时间和距离均有所减少，表明表现和精度提高。
总体而言，模拟培训受到高度赞赏。与 CG 相比，TM 组在我们认为更具空间视觉挑战性的绳索竞赛任务中表现出更好的整体表现和更高的精度。我们建议，通过远程指导进行外科模拟器培训可以成为未来激发和提高腹腔镜基本技能培训的一种可行方式。
