Microsurgery Workout: A Novel Simulation Training Curriculum Based on Nonliving Models
Microsurgery Workout: A Novel Simulation Training Curriculum Based on Nonliving Models
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DOI：
10.1097/prs.0000000000002456
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发表时间：
2016-10-01
影响因子：
3.6
通讯作者：
Dagnino, Bruno
中科院分区：
文献类型：
--
作者：
Rodriguez, Jose R.;Yanez, Ricardo;Dagnino, Bruno
背景：目前，还没有完全基于非生物模型的有效培训计划。作者的目的是开发和验证基于非活体模型的显微外科培训计划，并评估技能向活体大鼠模型的转移。方法：在体外鸡模型上，对普通外科研究生3年级的住院医师进行了为期17节的评估，进行动静脉端到端吻合。程序由两名盲人专家使用有效的全球和具体量表(客观的技术技能结构化评估)和有效的核对表进行记录和评级。评估手术时间和通畅率。手部动作分析用于测量动作的经济性。训练结束后，住院医生在活体大鼠身上进行了动静脉端到端吻合术。在相同的模型中，将结果与六名经验丰富的外科医生进行比较。P<；0.05的值具有统计学意义。10名居民改善了动脉[10(范围，8至10)对28(范围，27至29)，p<；0.05；8(范围，7至9)对28(范围，27至28)，p<；0.05]和静脉[8(范围，8至11)对28(范围，27至28)，p<；0.05；8(范围，7至9)对28(范围，27至29)，p<；0.05，以及8(范围，7至9)对28(范围，27至29)，p<；0.05]的技术技能评分的中位数。两种方法的核对表得分也都有所提高(p<；0.05)。与有经验的外科医生相比，实习生的速度更慢，效率更低(p<；0.05)。在活体大鼠中，30min时动脉和静脉的通畅率分别为100%和50%。结论：受训人员获得了与有经验的外科医生相似的显著显微外科技能。获得的技能被转移到更复杂的现场模型中。
Background: Currently, there are no valid training programs based solely on nonliving models. The authors aimed to develop and validate a microsurgery training program based on nonliving models and assess the transfer of skills to a live rat model.Methods: Postgraduate year-3 general surgery residents were assessed in a 17-session program, performing arterial and venous end-to-end anastomosis on ex vivo chicken models. Procedures were recorded and rated by two blinded experts using validated global and specific scales (objective structured assessment of technical skills) and a validated checklist. Operating times and patency rates were assessed. Hand-motion analysis was used to measure economy of movements. After training, residents performed an arterial and venous end-to-end anastomosis on live rats. Results were compared to six experienced surgeons in the same models. Values of p < 0.05 were considered statistically significant.Results: Learning curves were achieved. Ten residents improved their median global and specific objective structured assessment of technical skills scores for artery [10 (range, 8 to 10) versus 28 (range, 27 to 29), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 28), p < 0.05] and vein [8 (range, 8 to 11) versus 28 (range, 27 to 28), p < 0.05; and 8 (range, 7 to 9) versus 28 (range, 27 to 29), p < 0.05]. Checklist scores also improved for both procedures (p < 0.05). Trainees were slower and less efficient than experienced surgeons (p < 0.05). In the living rat, patency rates at 30 minutes were 100 percent and 50 percent for artery and vein, respectively.Conclusions: Significant acquisition of microsurgical skills was achieved by trainees to a level similar to that of experienced surgeons. Acquired skills were transferred to a more complex live model.