A simulation curriculum for laparoscopic common bile duct exploration, balloon sphincterotomy, and endobiliary stenting: Associations with resident performance and autonomy in the operating room.
A simulation curriculum for laparoscopic common bile duct exploration, balloon sphincterotomy, and endobiliary stenting: Associations with resident performance and autonomy in the operating room.
复制标题
腹腔镜胆总管探查、球囊括约肌切开术和胆内支架置入术的模拟课程：与手术室住院医师表现和自主权的关联。
DOI：
10.1016/j.surg.2022.11.007
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发表时间：
2023
期刊：
影响因子：
3.8
通讯作者：
Loftus,TylerJ
中科院分区：
文献类型：
--
作者：
Nyren,MollyQ;Filiberto,AmandaC;Underwood,PatrickW;Abbott,KennethL;Balch,JeremyA;Efron,PhilipA;George,BrianC;Shickel,Benjamin;UpchurchJr,GilbertR;SarosiJr,GeorgeA;Loftus,TylerJ
背景腹腔镜胆总管探查术是治疗胆总管结石安全有效的方法，但腹腔镜胆总管探查术很少实施，这影响了外科实习生的熟练程度。本研究测试的假设，即先前的手术或模拟经验与腹腔镜胆总管探查术与更大的居民手术性能和自主权，而不会对患者outcome.MethodsThis纵向队列研究包括33例连续患者进行腹腔镜胆总管探查术的情况下，涉及研究生年3，4，和5名普通外科住院医师在一个单一的机构期间，实施腹腔镜胆总管探查模拟课程。对于每一个33例，居民的表现和自主权进行了评价的居民和主治医生，居民的手术和模拟经验的记录，并从电子健康记录中确定患者的结果进行比较3个队列：以前的手术经验，以前的模拟经验，并没有以前的experience.ResultsOperative方法是相似的队列之间。总体发病率为6.1%，各队列相似。根据住院医师（3.0 [2.8-3.0] vs 2.0 [2.0-3.0];P= 0.01）和主治医师（3.0 [3.0-4.0];P<0.001），既往经验队列的手术性能评分较高。根据住院医师（2.0 [2.0-3.0] vs 2.0 [2.0-2.0];P= 0.005）和主治医师（2.5 [2.0-3.0] vs 2.0 [1.0-2.0];P= 0.001），既往经验队列的自主性评分较高。先前的模拟和先前的手术经验与性能和autonomy.ConclusionSimulation腹腔镜胆总管探查的经验与更大的居民手术性能和自主性，模仿先前的手术经验的影响有类似的关联。这说明了基于模拟的培训，以提高居民的腹腔镜胆总管探查术的操作性能和自主权的潜力。
BackgroundLaparoscopic common bile duct exploration is safe and effective for managing choledocholithiasis, but laparoscopic common bile duct exploration is rarely performed, which threatens surgical trainee proficiency. This study tests the hypothesis that prior operative or simulation experience with laparoscopic common bile duct exploration is associated with greater resident operative performance and autonomy without adversely affecting patient outcomes.MethodsThis longitudinal cohort study included 33 consecutive patients undergoing laparoscopic common bile duct exploration in cases involving postgraduate years 3, 4, and 5 general surgery residents at a single institution during the implementation of a laparoscopic common bile duct exploration simulation curriculum. For each of the 33 cases, resident performance and autonomy were rated by residents and attendings, the resident’s prior operative and simulation experience were recorded, and patient outcomes were ascertained from electronic health records for comparison among 3 cohorts: prior operative experience, prior simulation experience, and no prior experience.ResultsOperative approach was similar among cohorts. Overall morbidity was 6.1% and similar across cohorts. The operative performance scores were higher in prior experience cohorts according to both residents (3.0 [2.8–3.0] vs 2.0 [2.0–3.0];P= .01) and attendings (3.0 [3.0–4.0];P< .001). The autonomy scores were higher in prior experience cohorts according to both residents (2.0 [2.0–3.0] vs 2.0 [2.0–2.0];P= .005) and attendings (2.5 [2.0–3.0] vs 2.0 [1.0–2.0];P= .001). Prior simulation and prior operative experience had similar associations with performance and autonomy.ConclusionSimulation experience with laparoscopic common bile duct exploration was associated with greater resident operative performance and autonomy, with effects that mimic prior operative experience. This illustrates the potential for simulation-based training to improve resident operative performance and autonomy for laparoscopic common bile duct exploration.