目的 评估远程与现场模拟教学在腹腔镜外科基础操作培训中的应用效果。方法 选取2012年11月~2015年8月在北京大学人民医院临床能力培训中心培训的53名学员为研究对象,随机分为实验组和对照组,实验组22人采用远程教学,对照组31人采用现场教学。同一教师进行教学,培训前后,采用该培训规定的5项基本操作评估体系对两组学员进行评估并对他们的得分进行比较。结果 所有学员操作评估得分,培训前为(55.3±6.6)分,培训后为(89.3±5.3)分,差异具有统计学意义(P＜0.001)。培训前,对照组与实验组学员操作评估得分分别为(61.8±6.5)和(46.1±7.2),对照组学员成绩优于实验组学员,差异具有统计学意义(P＜0.001);培训后,对照组和实验组学员操作评估得分分别为(89.6±4.8)和(89.0±6.0)分,差异无统计学意义(P=0.66)。结论 腹腔镜外科基础操作培训可以有效地提高受训者的腹腔镜操作水平,远程教学的效果不亚于现场教学,值得推广。
Objective To evaluate the effect of using tele-simulation and on-site method for teaching the fundamentals of laparoscopic surgery skills training.Methods A total of 53 surgeons were selected from Peking University People's Hospital participated in this 8-week fundamentals of laparoscopic surgery(FLS) training from November, 2012 to August, 2015. Tele-simulation was set up for 22 surgeons as experimental group. A standard FLS on-site training for the 33 surgeons was as control group. FLS's skills pretest and post-test scores were obtained in both groups.Results Participants had higher post-test FLS scores(89.3±5.3) than their pretest's(55.3±6.6), and it showed statistical difference(P<0.001). Between the two groups, control group had higher pretest FLS scores(61.8±6.5) than that of experimental group (46.1±7.2), and it showed statistical difference(P<0.001). There was no statistical difference in the post-test FLS scores between them(P=0.66).Conclusions Fundamentals of laparoscopic surgery skills training can significantly improve the laparoscopic skills of the trainees. Tele-simulation is an effective method for the fundamentals of laparoscopic surgery skills training.
[1] 王宇. 微创外科的兴起、发展与未来[J].中华肝胆外科杂
志,2006,12(3):145-148.
[2] 钟艳, 胡继雄, 何庆南. 浅谈微创外科医师的培养[J].中华医学教育杂志,2006,26(2):81-83.
Zhong Y, Hu JX, He QN. A simple talk about training minimally invasive surgeons[J].Chin J Med Edu, 2006, 26(2):81-83.
[3] Gallagher AG, Ritter EM, Satava RM. Fundamental principles of validation, and reliability: rigorous science for the assessment of surgical education and training[J]. Surg Endosc, 2003,17(10):1525-1529. DOI: 10.1007/s00464-003-0035-4.
[4] Fried GM, Feldman LS, Vassiliou MC, et al. Proving the value of simulation in laparoscopic surgery[J]. Ann Surg, 2004,240(3):518-525.
[5] Okrainec A, Henao O, Azzie G. Tele-simulation: an effective method for teaching the fundamentals of laparoscopic surgery in resource-restricted countries[J]. Surg Endosc, 2010,24(2):417-422. DOI: 10.1007/s00464-009-0572-6.
[6] Peters JH, Fried GM, Swanstrom LL, et al. Development and validation of a comprehensive program of education and assessment of the basic fundamentals of laparoscopic surgery[J]. Surgery, 2004,135(1):21-27. DOI: 10.1016/S0039.
[7] 李靖, 梁平, 杨彤翰, 等. 腹腔镜外科技术教学方法探讨[J].中国高等医学教育,2005(6):69-70,92.
[8] 王存川. 关于腹腔镜外科手术教学方法的探讨[J].中国内镜杂志,2003,9(6):93-94.
[9] 卢先州, 张树友, 彭秀达, 等. 腹腔镜操作训练在普外科临床教学中应用的探讨[J].中国高等医学教育,2010(7):98-99.
Lu XZ,Zhang SY, Peng XD, et al. Laparoscopic procedure training for bed side teaching of general surgery[J].China Higher Medical Education,2010(7):98-99.
[10] Okrainec A, Smith L, Azzie G. Surgical simulation in Africa: the feasibility and impact of a 3-day fundamentals of laparoscopic surgery course[J]. Surg Endosc, 2009,23(11):2493-2498. DOI: 10.1007/s00464-009-0424-4.
[11] Mikrogianakis A, Kam A, Silver S, et al. Tele-simulation: an innovative and effective tool for teaching novel intraosseous insertion techniques in developing countries[J]. Acad Emerg Med, 2011,18(4):420-427. DOI: 10.1111/j.1553-2712.2011.01038.x.
[12] Burckett-St LDA, Cunningham MS, Abbas S, et al. Teaching ultrasound-guided regional anesthesia remotely: a feasibility study[J]. Acta Anaesthesiol Scand, 2016,60(7):995-1002. DOI: 10.1111/aas.12695.
