Do Skills Acquired from Training with a Wire Navigation Simulator Transfer to a Mock Operating Room Environment?
Do Skills Acquired from Training with a Wire Navigation Simulator Transfer to a Mock Operating Room Environment?
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DOI：
10.1097/corr.0000000000000799
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发表时间：
2019-10-01
影响因子：
4.2
通讯作者：
Anderson, Donald D.
中科院分区：
文献类型：
--
作者：
Long, Steven A.;Thomas, Geb;Anderson, Donald D.
背景技能训练和模拟在骨科教育中发挥着越来越重要的作用。模拟的目的是提高在手术室（OR）中的表现，这是一种被称为转移有效性的特征。以前没有研究探讨如何基于模拟器的导线导航训练可以转移到更高层次的任务。此外，还缺乏关于导丝导航培训应采用的形式的知识。问题/目的（1）哪种培训方法（教学内容、刻意练习或基于熟练度的练习）能最大程度地改善导丝导航任务的执行情况？(2)住院医师使用导丝导航模拟器的表现是否与其在模拟手术室中执行更高级别模拟任务（包括C形臂、不透射线股骨模型和股骨周围的大型软组织替代物）的表现相关？方法来自四个不同医疗中心的55名居民参加了这项为期2年的研究。住院医师被分为三组：传统培训（包括来自爱荷华州大学、明尼苏达大学和马约诊所的第一年住院医师）、刻意练习（包括来自内布拉斯加大学和明尼苏达大学的第一年住院医师）和熟练培训（包括来自明尼苏达大学和马约诊所的第一年住院医师）。每组的住院医生都接受了一个教学介绍，包括放置钢丝治疗转子间骨折的任务，这被认为是传统的培训。刻意练习包括在无辐射模拟器上进行训练，该模拟器在整个练习过程中提供特定的反馈。熟练度培训使用相同的模拟器对导丝导航的特定组件进行培训，例如找到正确的起点，在进行评估之前达到熟练度。导丝导航模拟器使用摄像机系统跟踪导丝并提供计算机生成的荧光透视。训练后，在模拟手术室中评估任务表现。在模拟手术室中，根据他们使用荧光透视、总时间和尖端-尖端距离对每组的住院医生进行评估。结果两组住院医师在模拟手术室中的表现均低于传统手术室中的表现（教学训练尖端-尖端距离：24 +/- 7 mm，95% CI，20-27;刻意练习尖端尖端距离：16 +/- 5 mm，95% CI，13-19，p = 0.001;熟练训练尖端-顶点距离：15 +/- 4 mm，95% CI，13-18，p < 0.001）。熟练培训组的住院医师使用的图像比其他组的住院医师使用的图像更多（教学培训：22 +/- 12张图像，p = 0.041;刻意练习：19 +/- 8张图像; p = 0.012，熟练培训：31 +/- 14张图像）。在两个基于模拟的培训组中，模拟器上的住院医师表现，即尖端-顶点距离、图像使用和总时间，与模拟手术室中的表现相关（r平方= 0.15 [p = 0.030]、0.61 [p < 0.001]和0.43 [p < 0.001]，结论：住院医师项目正在设计他们的课程来训练钢丝导航技能，重点应该放在提供一个环境上，允许有意识的练习，并立即反馈他们的表现。本研究中介绍的模拟器为居民学习这一关键技能提供了安全的环境。
Background Skills training and simulation play an increasingly important role in orthopaedic surgical education. The intent of simulation is to improve performance in the operating room (OR), a trait known as transfer validity. No prior studies have explored how simulator-based wire navigation training can transfer to higher-level tasks. Additionally, there is a lack of knowledge on the format in which wire navigation training should be deployed.Questions/purposes (1) Which training methods (didactic content, deliberate practice, or proficiency-based practice) lead to the greatest improvement in performing a wire navigation task? (2) Does a resident's performance using a wire navigation simulator correlate with his or her performance on a higher-level simulation task in a mock OR involving a C-arm, a radiopaque femur model, and a large soft tissue surrogate surrounding the femur?Methods Fifty-five residents from four different medical centers participated in this study over the course of 2 years. The residents were divided into three groups: traditional training (included first-year residents from the University of Iowa, University of Minnesota, and the Mayo Clinic), deliberate practice (included first-year residents from the University of Nebraska and the University of Minnesota), and proficiency training (included first-year residents from the University of Minnesota and the Mayo Clinic). Residents in each group received a didactic introduction covering the task of placing a wire to treat an intertrochanteric fracture, and this was considered traditional training. Deliberate practice involved training on a radiation-free simulator that provided specific feedback throughout the practice sessions. Proficiency training used the same simulator to train on specific components of wire navigation, like finding the correct starting point, to proficiency before moving to assessment. The wire navigation simulator uses a camera system to track the wire and provide computer-generated fluoroscopy. After training, task performance was assessed in a mock OR. Residents from each group were assessed in the mock OR based on their use of fluoroscopy, total time, and tip-apex distance. Correlation analysis was performed to examine the relationship between resident performance on the simulator and in the mock OR.Results Residents in the two simulation-based training groups had a lower tip-apex distance than those in the traditional training group (didactic training tip-apex distance: 24 +/- 7 mm, 95% CI, 20-27; deliberate practice tip apex distance: 16 +/- 5 mm, 95% CI, 13-19, p = 0.001; proficiency training tip-apex distance: 15 +/- 4 mm, 95% CI, 13-18, p < 0.001). Residents in the proficiency training group used more images than those in the other groups (didactic training: 22 +/- 12 images, p = 0.041; deliberate practice: 19 +/- 8 images; p = 0.012, proficiency training: 31 +/- 14 images). In the two simulation-based training groups, resident performance on the simulator, that is, tip-apex distance, image use, and overall time, was correlated with performance in the mock OR (r-square = 0.15 [p = 0.030], 0.61 [p < 0.001], and 0.43 [p < 0.001], respectively).Conclusions As residency programs are designing their curriculum to train wire navigation skills, emphasis should be placed on providing an environment that allows for deliberate practice with immediate feedback about their performance. Simulators such as the one presented in this study offer a safe environment for residents to learn this key skill.