Rogers D A, Regehr G, Yeh K A, Howdieshell T R
Department of Surgery, Medical College of Georgia, Augusta 30912-4070, USA.
Am J Surg. 1998 Jun;175(6):508-10. doi: 10.1016/s0002-9610(98)00087-7.
Rapid improvements in computer technology allow us to consider the use of computer-assisted learning (CAL) for teaching technical skills in surgical training. The objective of this study was to compare in a prospective, randomized fashion, CAL with a lecture and feedback seminar (LFS) for the purpose of teaching a basic surgical skill.
Freshman medical students were randomly assigned to spend 1 hour in either a CAL or LFS session. Both sessions were designed to teach them to tie a two-handed square knot. Students in both groups were given knot tying boards and those in the CAL group were asked to interact with the CAL program. Students in the LFS group were given a slide presentation and were given individualized feedback as they practiced this skill. At the end of the session the students were videotaped tying two complete knots. The tapes were independently analyzed, in a blinded fashion, by three surgeons. The total time for the task was recorded, the knots were evaluated for squareness, and each subject was scored for the quality of performance.
Data from 82 subjects were available for the final analysis. Comparison of the two groups demonstrated no significant difference between the proportion of subjects who were able to tie a square knot. There was no difference between the average time required to perform the task. The CAL group had significantly lower quality of performance (t = 5.37, P <0.0001).
CAL and LFS were equally effective in conveying the cognitive information associated with this skill. However, the significantly lower performance score demonstrates that the students in the CAL group did not attain a proficiency in this skill equal to the students in the LFS group. Comments by the students suggest that the lack of feedback in this model of CAL was the significant difference between these two educational methods.
计算机技术的迅速发展使我们能够考虑将计算机辅助学习（CAL）用于外科手术培训中的技能教学。本研究的目的是以前瞻性、随机的方式比较CAL与讲座及反馈研讨会（LFS）在教授一项基本外科技能方面的效果。
将大一医学生随机分配，让他们分别参加1小时的CAL课程或LFS课程。两个课程均旨在教授他们打双手方结。两组学生都被给予打结板，CAL组的学生被要求与CAL程序进行互动。LFS组的学生观看幻灯片演示，并在练习该技能时获得个性化反馈。课程结束时，对学生打两个完整结的过程进行录像。录像带由三位外科医生以盲法独立分析。记录完成任务的总时间，评估结的方正度，并对每个受试者的操作质量进行评分。
82名受试者的数据可用于最终分析。两组比较显示，能够打出方结的受试者比例之间无显著差异。完成任务所需的平均时间也没有差异。CAL组的操作质量明显较低（t = 5.37，P <0.0001）。
CAL和LFS在传达与该技能相关的认知信息方面同样有效。然而，操作评分明显较低表明，CAL组的学生在这项技能上没有达到与LFS组学生相同的熟练程度。学生的评论表明，这种CAL模式缺乏反馈是这两种教育方法之间的显著差异。
