Cabello Ramiro, Bueno-Serrano Gonzalo, Arteche Alberto Hernando, Villacampa José Miguel, Castilla Carlos, Carnero Carlos, Garranzo Garcia-Ibarrola María, Gonzalez Enguita Carmen
Department Urology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
Department Otorhinolaryngology, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.
Adv Med Educ Pract. 2024 May 27;15:451-459. doi: 10.2147/AMEP.S450513. eCollection 2024.
Learning laparoscopy (LAP) is challenging and requires different skills to conventional open surgery. There is a recognized need for a standardized laparoscopic training framework within urology to overcome these difficulties and to shift learning curve from patient to skills laboratory. Simulation-based training has been widely commented, but implementation in real day practice is lacking. We present our "LAP training program for residents".
Between 2017 and 2022, 11 residents participated in our self-designed program: Theoretical: (Moodle platform) basic knowledge and multimedia content for initiation into LAP. Evaluated through online exam. Practical: exercises for LAP skills acquisition were proposed and encouraged residents' practice in a box trainer available and experimental surgery sessions on a porcine model. On-site E-BLUS (European Basic Laparoscopic Urologic Skills) examination was performed annually. Feedback was obtained through an anonymous online survey.
All residents positively evaluated the program. Theoretical: 82% passed the online exam. The most valued topics: LAP in special clinical situations, complications, instruments, and configuration of the operating room (OR). Practical: all residents increased dry-lab box practices. A total of 23 experimental surgical sessions were carried out. For 64%, simulation in the experimental OR was a necessary complement to achieve laparoscopic skills and allowed them to feel more confident. Forty-five percent considered it essential to improve their surgical technique. E-BLUS evaluation was valued as a means to achieve dexterity and safer surgery by 90%. Reduction in time and errors were observed through time, although only 2 passed the E-BLUS.
Our program for learning LAP includes the acquisition of knowledge, training of basic skills and surgical technique in a safe environment, as well as an objective evaluation. Encouraged practice of basic skills and surgical technique simulation and improved objective evaluation. It is structured, reproducible, systematic and has been positively valued, although it requires commitment for success.
学习腹腔镜手术具有挑战性，需要与传统开放手术不同的技能。人们认识到，泌尿外科需要一个标准化的腹腔镜培训框架，以克服这些困难，并将学习曲线从患者转移到技能实验室。基于模拟的培训已得到广泛评论，但在实际日常实践中的应用却很缺乏。我们介绍我们的“住院医师腹腔镜培训计划”。
2017年至2022年期间，11名住院医师参加了我们自行设计的计划：理论：（Moodle平台）腹腔镜手术入门的基础知识和多媒体内容。通过在线考试进行评估。实践：提出了腹腔镜手术技能获取练习，并鼓励住院医师在可用的箱式训练器中练习以及在猪模型上进行实验性手术。每年进行现场欧洲泌尿外科基本腹腔镜技能（E-BLUS）考试。通过匿名在线调查获得反馈。
所有住院医师对该计划给予了积极评价。理论：82%通过了在线考试。最受重视的主题：特殊临床情况下的腹腔镜手术、并发症、器械以及手术室配置。实践：所有住院医师增加了干式模拟练习。共进行了23次实验性手术。对于64%的人来说，实验手术室中的模拟是获得腹腔镜技能的必要补充，并使他们更有信心。45%的人认为这对提高他们的手术技术至关重要。90%的人认为E-BLUS评估是实现灵活性和更安全手术的一种方式。随着时间的推移，观察到时间和错误有所减少，尽管只有2人通过了E-BLUS。
我们的腹腔镜手术学习计划包括在安全环境中获取知识、基本技能和手术技术培训，以及客观评估。鼓励基本技能和手术技术模拟练习并改进客观评估。它具有结构性、可重复性、系统性且得到了积极评价，但要取得成功需要付出努力。
