目的 在不同年资外科医师非手术定向腹腔镜模拟训练中,探讨形成性评估应用的可行性及意义。方法 选取北京大学第三医院泌尿外科55名不同年资外科医师为研究对象,含外科进修医师42人和专业学位研究生13人。对他们进行连续4周的非手术定向腹腔镜模拟训练,实验组29名医师采用形成性评估,对照组26名医师采用终结性评估,分别对其培训前后的操作进行量化评分和统计分析。结果 所有医师在培训后操作评分均有明显上升,进修医师的缝合打结提升幅度显著高于研究生,且差异具有统计学意义[(17.1±2.9)vs(14.2±3.5),t=2.97,P=0.004]。研究生中,培训后实验组的基础操作考核成绩更高且差异具有统计学意义[(12.6±0.8)vs(9.0±0.6),t=-8.91,P=0.000];进修医师中,培训后实验组的缝合打结成绩更高且差异具有统计学意义[(35.2±2.5)vs(33.0±2.5),t=-2.83,P=0.007]。形成性评估中研究生与进修医师的成绩变化曲线存在差异。结论 非手术定向腹腔镜模拟训练对不同年资外科医师均可行,可以提高腹腔镜操作水平,外科学研究生与外科进修医师培训效果存在差异。在腹腔镜模拟培训中应用形成性评估,对于提高各年资外科医师的培训效果均有积极意义。
Objective To explore the feasibility and effect of the application of the formative assessment in nonprocedural laparoscopic simulating training for surgeons in different seniorities.Methods A total of 55 surgeons in different seniorities were selected from Peking University Third Hospital as research object, including 42 refresher doctors on surgery and 13 graduate students on surgery for master degree. For them, a 4-week nonprocedural laparoscopic simulating training was carried out, in which the formative assessment was set up for 29 trainees as experimental group, and the summative assessment for the other 26 trainees as control group. The laparoscopic skills before and after training were evaluated in scores and compared statistically in both groups.Results All trainees had higher laparoscopic skills post-test scores than their pretest's, but the enhancement in suturing and knotting test for refresher doctors (17.1±2.9) was statistically higher than that for graduate students(14.2±3.5)(t=2.97,P=0.004). In graduate students, statistically higher scores in the basic skills post-test was obtained in experimental group[(12.6±0.8)vs(9.0±0.6), t =-8.91, P =0.000]. In refresher doctors, statistically higher scores in suturing-knotting post-test was obtained in experimental group[(35.2±2.5)vs(33.0±2.5),t=-2.83,P=0.007]. Formative assessment showed different trends in the curves of skill enhancement between surgical refresher doctors and graduate students.Conclusions Nonprocedural laparoscopic simulating training can feasibly improve laparoscopic skills, with variety between surgical refresher doctors and graduate students. Formative assessment is an effective method for surgeons in different seniorities during laparoscopic simulating training.
[1] 尹大龙,薄红,宋宣,等.腹腔镜外科医师技能培训的新进展[J]. 中华医学教育杂志,2010,30(3):459-461. DOI:10.3760/cma.j.issn.1673-677X.2010.03.055.
Yin DL, Bo H, Song X, et al.Improvement of learning and training on fundamental knowledge and technical skills in laparoscopic surgery [J]. Chin J Med Edu, 2010, 30(3): 459-461. DOI: 10.3760/cma.j.issn.1673-677X.2010.03.055.
[2] Dawidek MT, Roach VA, Ott MC, et al.Changing the learning curve in novice laparoscopists: Incorporating direct visualization into the simulation training program [J]. J Surg Educ,2017, 74(1): 30-36. DOI: 10.1016/j.jsurg.2016.07.012.
[3] 高嵩,杨尹默,王颖,等.非手术定向模拟腹腔镜训练在八年制医学生临床教学中的应用[J]. 中华医学教育杂志,2009,29(2):100-102. DOI:10.3760/cma.j.issn.1673-677X.2009.02.038.
Gao S, Yang YM, Wang Y, et al.Laparoscopic training of nonprocedural simulating in eight-year program clinical medical education [J]. Chin J Med Edu, 2009, 29(2): 100-102. DOI: 10.3760/cma.j.issn.1673-677X.2009.02.038.
[4] 朱俊勇,董卫国,王燕霞,等.构建形成性评估体系提高临床医学教学质量[J]. 中华医学教育杂志,2013,33(2):299-301. DOI:10.3760/cma.j.issn.1673-677X.2013.02.047.
Zhu JY, Dong WG, Wang YX, et al.Constructing formative assessment system and promoting the quality of clinical medical teaching [J]. Chin J Med Edu,2013, 33(2):299-301. DOI:10.3760/cma.j.issn.1673-677X.2013.02.047.
[5] 纪艳超,许军.腹腔镜基本技能的模拟训练[J]. 中华医学教育探索杂志,2012,11(10):1033-1035. DOI:10.3760/cma.j.issn.2095-1485.2012.10.016.
Ji YC, Xu J.Simulation training of laparoscopic basic skills[J]. Chin J Med Edu Res, 2012, 11(10): 1033-1035. DOI: 10.3760/cma.j.issn.2095-1485.2012.10.016.
[6] 叶欣,陆君阳,韩显林,等.不同培训频率对腹腔镜模拟培训初学者训练效果的影响[J]. 中国微创外科杂志,2017,17(6):553-556. DOI:10.3969/j.issn.1009-6604.2017.06.021.
Ye X,Lu JY,Han XL,et al.Impact of different training frequency on training effects of simulation-based laparoscopic training curriculum for beginners [J]. Chin J Mini Inva Surg, 2017, 17(6): 553-556. DOI:10.3969/j.issn.1009-6604.2017.06.021.
[7] 金石华,张弋,孙国锋,等.腹腔镜模拟训练对不同经验医生腹腔镜手术基本技能训练的效果[J]. 中国内镜杂志,2014,20(1):34-37.
Jin SH, Zhang Y, Sun GF, et al.Effect of laparoscopic simulate training on improvement of basic skills of surgeons with different experience [J]. Chinese Journal of Endoscopy, 2014, 20(1): 34-37.
[8] Kurashima Y, Hirano S.Systematic review of the implementation of simulation training in surgical residency curriculum [J]. Surg Today, 2017, 47(7): 777-782. DOI: 10.1007/s00595-016-1455-9.
[9] Oestergaard J, Larsen CR, Maagaard M, et al.Can both residents and chief physicians assess surgical skills [J]? Surg Endosc, 2012, 26(7): 2054-2060. DOI: 10.1007/s00464-012-2155-1.
[10] 魏波,邓美海,郑宗珩,等.医学本科生早期腹腔镜技术培训的探索[J]. 中华医学教育杂志,2012,32(5):763-765. DOI:10.3760/cma.j.issn.1673-677X.2012.05.043.
Wei B, Deng MH, Zheng ZH, et al.Investigation of laparoscopic training for medical undergraduates [J]. Chin J Med Edu, 2012, 32(5): 763-765. DOI: 10.3760/cma.j.issn.1673-677X.2012.05.043.
[11] McKendy KM, Watanabe Y, Bilgic E, et al.Establishing meaningful benchmarks: The development of a formative feedback tool for advanced laparoscopic suturing [J]. Surg Endosc, 2017, 31(12): 5057-5065. DOI:10.1007/s00464-017-5569-y.
