Division of Trauma and Emergency Surgery, Department of Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
Department of Thoracic and Cardiovascular Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
BMC Med Educ. 2024 Oct 8;24(1):1109. doi: 10.1186/s12909-024-06090-x.
Laparoscopic surgery is associated with a prolonged learning curve for emerging surgeons, and simulation-based training (SBT) has become increasingly prominent in this context due to stringent working time regulations and heightened concerns regarding patient safety. While SBT offers a safe and ethical learning environment, the accuracy of simulators in the context of evaluating surgical skills remains uncertain. This study aims to assess the precision of a laparoscopic simulator with regard to evaluating surgical performance and to identify the instructor's role in SBT.
This retrospective study focused on surgical residents in their 1st through 5th years at the Department of Surgery of Linkou Chang Gung Memorial Hospital. The residents participated in a specially designed SBT program using the LapSim laparoscopic simulator. Following the training session, each resident was required to perform a laparoscopic procedure and received individualized feedback from an instructor. Both simulator and instructor evaluated trainees' performance on the LapSim, focusing on identifying correlations between the simulator's metrics and traditional assessments.
Senior residents (n = 15), who employed more complex laparoscopic procedures, exhibited more significant improvements after receiving instructor feedback than did junior residents (n = 17). Notably, a stronger correlation between the simulator and instructor assessments was observed in the junior group (junior Global Operative Assessment of Laparoscopic Skills (GOALS) adjusted R = 0.285, p = 0.016), while no such correlations were observed among the senior group.
A well-designed, step-by-step SBT can be a valuable tool in laparoscopic surgical training. LapSim simulator has demonstrated its potential in assessing surgical performances during the early stages of surgical training. However, instructors must provide intuitive feedback to ensure appropriate learning in later stages.
对于新兴外科医生来说，腹腔镜手术相关操作具有较长的学习曲线，由于严格的工作时间规定以及对患者安全的高度关注，基于模拟的培训（SBT）在这种情况下变得越来越突出。虽然 SBT 提供了安全和合乎道德的学习环境，但模拟器在评估手术技能方面的准确性仍不确定。本研究旨在评估腹腔镜模拟器在评估手术表现方面的准确性，并确定 SBT 中教师的作用。
这是一项回顾性研究，专注于林口长庚纪念医院外科部的 1 至 5 年级外科住院医师。住院医师参加了使用 LapSim 腹腔镜模拟器设计的专门 SBT 计划。培训课程结束后，每位住院医师都需要进行腹腔镜手术，并接受来自教师的个性化反馈。模拟器和教师都对学员在 LapSim 上的表现进行了评估，重点是确定模拟器指标与传统评估之间的相关性。
高级住院医师（n=15）进行了更复杂的腹腔镜手术，在接受教师反馈后表现出更显著的改善，而初级住院医师（n=17）则没有。值得注意的是，在初级组中观察到模拟器和教师评估之间的相关性更强（初级全球腹腔镜技能评估（GOALS）调整 R=0.285，p=0.016），而在高级组中则没有观察到这种相关性。
精心设计的逐步 SBT 可以成为腹腔镜手术培训的有价值工具。LapSim 模拟器在评估手术培训早期的手术表现方面显示出了潜力。然而，教师必须提供直观的反馈，以确保在后期阶段的适当学习。
