Feenstra Tim M, van der Storm Sebastiaan L, Barsom Esther Z, Bonjer Jaap H, Nieveen van Dijkum Els J M, Schijven Marlies P
Department of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, the Netherlands.
Amsterdam Gastroenterology, Endocrinology and Metabolism, Amsterdam, the Netherlands.
Surg Open Sci. 2023 Oct 4;16:100-110. doi: 10.1016/j.sopen.2023.10.002. eCollection 2023 Dec.
Digital tools like digital box trainers and VR seem promising in delivering safe and tailored practice opportunities outside of the surgical clinic, yet understanding their efficacy and limitations is essential. This study investigated digital tools are available to train surgical skills, these tools are used, effective they are, and skills they are intended to teach.
Medline, Embase, and Cochrane libraries were systematically reviewed for randomized trials, evaluating digital skill-training tools based on objective outcomes (skills scores and completion time) in surgical residents. Digital tools effectiveness were compared against controls, wet/dry lab training, and other digital tools. Tool and training factors subgroups were analysed, and studies were assessed on their primary outcomes: technical and/or non-technical.
The 33 included studies involved 927 residents and six digital tools; digital box trainers, (immersive) virtual reality (VR) trainers, robot surgery trainers, coaching and feedback, and serious games. Digital tools outperformed controls in skill scores (SMD 1.66 [1.06, 2.25], < 0.00001, I = 83 %) and completion time (SMD -1.05 [-1.72, -0.38], = 0.0001, I = 71 %). There were no significant differences between digital tools and lab training, between tools, or in other subgroups. Only two studies focussed on non-technical skills.
While the efficacy of digital tools in enhancing technical surgical skills is evident - especially for VR-trainers -, there is a lack of evidence regarding non-technical skills, and need to improve methodological robustness of research on new (digital) tools before they are implemented in curricula.
This study provides critical insight into the increasing presence of digital tools in surgical training, demonstrating their usefulness while identifying current challenges, especially regarding methodological robustness and inattention to non-technical skills.
数字箱式训练器和虚拟现实（VR）等数字工具在手术诊所之外提供安全且量身定制的练习机会方面似乎很有前景，但了解它们的功效和局限性至关重要。本研究调查了有哪些数字工具可用于训练手术技能、这些工具的使用情况、它们的有效性以及它们旨在教授的技能。
对Medline、Embase和Cochrane图书馆进行系统综述，以查找随机试验，这些试验基于外科住院医师的客观结果（技能得分和完成时间）评估数字技能训练工具。将数字工具的有效性与对照组、湿/干实验室培训和其他数字工具进行比较。分析工具和培训因素亚组，并根据其主要结果（技术和/或非技术）对研究进行评估。
纳入的33项研究涉及927名住院医师和六种数字工具；数字箱式训练器、（沉浸式）虚拟现实（VR）训练器、机器人手术训练器、指导与反馈以及严肃游戏。数字工具在技能得分（标准化均数差1.66 [1.06, 2.25]，P < 0.00001，I² = 83%）和完成时间（标准化均数差 -1.05 [-1.72, -0.38]，P = 0.0001，I² = 71%）方面优于对照组。数字工具与实验室培训之间、工具之间或其他亚组之间没有显著差异。只有两项研究关注非技术技能。
虽然数字工具在提高手术技术技能方面的功效是明显的——尤其是对于VR训练器——但缺乏关于非技术技能的证据，并且在将新的（数字）工具纳入课程之前，需要提高研究的方法学稳健性。
本研究为手术培训中数字工具的日益普及提供了重要见解，展示了它们的有用性，同时识别了当前的挑战，特别是在方法学稳健性和对非技术技能的忽视方面。
