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首页> 外文期刊>The Internet Journal of Medical Simulation >An Educational Program Using A Bladder Model To Improve Diagnostic Cystourethroscopy Skills
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An Educational Program Using A Bladder Model To Improve Diagnostic Cystourethroscopy Skills

机译：使用膀胱模型提高诊断性膀胱尿道镜检查技能的教育计划

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Objective: To determine if an educational program with the use of a bladder model, constructed out of a rubber ball and balloon, improved surgical skills requisite in the performance of diagnostic cystourethroscopy. Methods: We created a bladder model out of a rubber ball and balloon. We invited all Obstetrics and Gynecology residents at The University of Texas Houston to participate in the study. We assigned participants to receive the intervention, interactive training and practice on a bladder model, or the usual education and teaching. All participants had baseline knowledge assessed using an Objective Structured Assessment of Technical Skills (OSATs) in August and November of 2008. The OSATs consisted of a Global Ratings Scale with pass/fail grade, task specific checklist of 11 items, written questionnaire, and time required to complete a diagnostic cystourethroscopy on the bladder model. We assessed post intervention knowledge and skills in a similar fashion in February and May of 2009. Statistical analyses were performed using the SAS statistical package. A p value of <.05 was considered statistically significant. Results: Forty one of 45 (91.1%) residents agreed to participate in the study. Twenty-five residents (60.9%) had complete information with pre and post intervention measurements. A trend in improved performance was seen in those that received the intervention versus control although none reached statistical significance. Inter-rater reliability was greatest for the pass/fail portion of the global rating scale. Conclusion: This model may be useful in training obstetric and gynecology residents in diagnostic cystourethroscopic procedures. Introduction Injury to the urinary tract during gynecologic surgery is not uncommon. In some series the ureteral injury rate is as high as 26.8/1000, with bladder injury at 29.1/10001. Diagnostic cystourethroscopy at the time of difficult gynecologic cases or cases where ureteral integrity is questioned has been shown to reliably identify ureteral injury2,3,4. As the population ages it is likely that the number of cases for stress urinary incontinence, and pelvic organ prolapse will increase5. Currently, training in diagnostic cystourethroscopy of gynecology residents varies across the nation. We designed an Objective Structured Assessment of Technical Skills (OSATS) using a bladder model, constructed out of a rubber ball and balloon, for teaching requisite skills necessary in the performance of diagnostic cystourethroscopy. The purpose of this study was to determine whether an educational program, assessed using the OSATS, improved the surgical skills necessary for the performance of diagnostic cystourethroscopy. Our hypothesis was that the use of this model and education provided in association with the use of this model would improve surgical skills compared to the group that did not receive training using the model. Materials and Methods We invited all residents of both obstetrics and gynecology training programs at The University of Texas Health Science Center at Houston (UTHSCH) to participate in the study. We fashioned a low cost bladder model out of a rubber ball and balloon. The rubber ball was approximately 4 cms in diameter, and in the center of the ball we created a 5mm urethra with the drill. The balloon fit snugly over the rubber ball, as depicted in the figure, and we attached the balloon and ball to the simulation table with a Velcro strap. We marked two areas in the balloon representing the ureteral orifi based on published anatomic criteria6, and also an area marking the dome of the bladder. We created a written questionnaire and 11 point task specific checklist (Figure 1) in regard to diagnostic cystourethroscopy. We created the checklist based on essential steps necessary to perform a diagnostic cystourethroscopy and those highlighted in a contemporary text7. The written questionnaire assessed the learners’ knowledge in regard to diagnostic cystourethroscopy
机译：目的：确定由橡胶球和气球构成的膀胱模型的教育计划是否提高了诊断性膀胱镜检查的必要手术技能。方法：我们用橡胶球和气球创建了一个膀胱模型。我们邀请了德克萨斯大学休斯顿分校的所有妇产科住院医师参加该研究。我们指派参与者接受膀胱模型的干预，互动式培训和实践，或者接受常规的教育和教学。所有参与者均于2008年8月和11月使用目标技能进行了结构化技术评估（OSAT），评估了基础知识。OSAT包括具有及格/不及格等级的全球评分量表，11项任务特定清单，书面调查表和时间需要完成膀胱模型的诊断性膀胱镜检查。我们以类似的方式在2009年2月和5月评估了干预后的知识和技能。使用SAS统计软件包进行统计分析。 P值<.05被认为具有统计学意义。结果：45名居民中的41名（91.1％）同意参加该研究。 25位居民（60.9％）掌握了干预前后的完整信息。尽管没有达到统计学显着性，但在接受干预与对照的患者中观察到了性能改善的趋势。评分员之间的可靠性对于全球评分等级的通过/失败部分最大。结论：该模型可能对培训妇产科住院医师进行诊断性膀胱镜检查程序有用。引言妇科手术中尿路损伤并不罕见。在某些系列中，输尿管损伤率高达26.8 / 1000，膀胱损伤率为29.1 / 10001。在困难的妇科病例或对输尿管完整性提出质疑的情况下，诊断性膀胱镜检查已被证明可以可靠地识别输尿管损伤2、3、4。随着人口老龄化，应激性尿失禁和盆腔器官脱垂的病例数可能会增加5。目前，全国妇科居民诊断性膀胱镜检查的培训有所不同。我们使用由橡胶球和气球制成的膀胱模型设计了客观的技术技能结构评估（OSATS），用于教授诊断性膀胱镜检查所需的必要技能。这项研究的目的是确定使用OSATS评估的教育计划是否提高了诊断性膀胱镜检查所必需的手术技能。我们的假设是，与未使用该模型进行训练的组相比，使用该模型以及与该模型一起使用提供的教育将提高手术技能。材料和方法我们邀请了休斯顿德克萨斯大学健康科学中心（UTHSCH）的所有妇产科培训计划的居民参加研究。我们用橡胶球和气球制作了一个低成本的膀胱模型。橡胶球的直径约为4厘米，在球的中心，我们用钻头创建了一个5毫米的尿道。如图所示，气球紧贴在橡胶球上，我们用魔术贴绑带将气球和球固定在仿真台上。根据公布的解剖学标准，我们在气球中标记了两个代表输尿管峡部的区域，以及标记膀胱穹顶的区域。我们创建了一份书面调查表和针对膀胱膀胱镜诊断的11点任务特定清单（图1）。我们基于执行诊断性膀胱镜检查的必要基本步骤以及当代文献中突出显示的步骤创建了清单。书面问卷评估了学习者在诊断性膀胱镜检查方面的知识

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