Baba Kenji, Hozaka Yuto, Tanabe Kan, Wada Masumi, Kuroshima Naoki, Takara Kinjo, Yoshidome Shizuka, Iio Shunya, Okubo Keishi, Uenosono Yoshikazu, Shimonosono Masakata, Kawasaki Yota, Sasaki Ken, Arigami Takaaki, Ohtsuka Takao
Department of Digestive Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan.
Department of Surgery and Digestive Surgery, Imamura General Hospital, Kagoshima, Japan.
Asian J Endosc Surg. 2025 Jan-Dec;18(1):e70007. doi: 10.1111/ases.70007.
Regional disparities in medical practice between urban and rural areas in Japan represent a critical issue, and extend to the field of surgical education. To address these disparities, we evaluated the effectiveness of simultaneous remote coaching across multiple facilities using a standardized laparoscopic training method.
A total of 28 trainees from a university hospital and 3 rural hospitals were categorized into remote and on-site coaching groups. The training curriculum included lectures, practical training, and assessments, conducted for 1 h per week using three sessions. The primary endpoint of the study was the change in time for ligation of one suture between the on-site and remote coaching groups, expressed as the median of the reduction suture time rate (RTR). Secondary endpoints included the RTR categorized by years of graduation and the results of a questionnaire survey of participants.
Participants included 19 trainees in postgraduate year (PGY) 1-2 and 9 those in PGY 3-5. The median suture ligation time for the first attempt was 145 s (remote: 136 s vs. on-site: 160 s; p = 0.33) and that for the third attempt was 51 s (remote: 33 s vs. direct: 52 s; p = 0.91). The median RTR was 57%, with no significant difference observed between the remote and on-site coaching groups (43.2% vs. 71.2%, p = 0.26). The trainees' ratings for the training were generally favorable, with median ratings of 4 (range: 3-5) for the content of practical skills and 5 (4, 5) for the distance learning aspect, based on a 5-point Likert scale.
Simultaneous remote laparoscopic training could be effective in reducing disparities in surgical education.
日本城乡地区医疗实践的区域差异是一个关键问题，并且这种差异也延伸到了外科教育领域。为了解决这些差异，我们使用标准化的腹腔镜训练方法评估了跨多机构同步远程指导的有效性。
来自一家大学医院和3家乡村医院的28名学员被分为远程指导组和现场指导组。培训课程包括讲座、实践培训和评估，每周进行3次，每次1小时。该研究的主要终点是现场指导组和远程指导组之间单根缝线结扎时间的变化，以减少缝线时间率（RTR）的中位数表示。次要终点包括按毕业年份分类的RTR以及参与者的问卷调查结果。
参与者包括19名1 - 2年级的研究生学员和9名3 - 5年级的研究生学员。首次尝试时缝线结扎的中位时间为145秒（远程：136秒 vs. 现场：160秒；p = 0.33），第三次尝试时为51秒（远程：33秒 vs. 现场：52秒；p = 0.91）。RTR的中位数为57%，远程指导组和现场指导组之间未观察到显著差异（43.2% vs. 71.2%，p = 0.26）。基于5分李克特量表（Likert scale），学员对培训的评价总体良好，实践技能内容的中位评分为4（范围：3 - 5），远程学习方面的中位评分为5（4, 5）。
同步远程腹腔镜训练可能有效地减少外科教育中的差异。
