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首页> 外文期刊>The Journal of Thoracic and Cardiovascular Surgery >A randomized evaluation of simulation training on performance of vascular anastomosis on a high-fidelity in vivo model: the role of deliberate practice.
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A randomized evaluation of simulation training on performance of vascular anastomosis on a high-fidelity in vivo model: the role of deliberate practice.

机译：在高保真体内模型上对血管吻合术进行模拟训练的随机评估：精心实践的作用。

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OBJECTIVES: There is mounting evidence supporting the benefit of surgical skills practice in a simulated environment. However, the use of simulation in cardiac surgical training has been limited. The purpose of the current trial was to examine the effect of independent and deliberate simulator practice, during nonclinical time, on the performance of an end-to-side microvascular anastomosis in an in vivo model. METHODS: This single-blinded, randomized controlled trial received institutional review board approval. Thirty-nine first- and second-year surgical trainees were randomized to an expert-guided tutorial on a procedural trainer or to the expert-guided tutorial combined with self-directed practice on the same procedural trainer. Self-directed practice consisted of 10 anastomoses performed on the procedural trainer: a low-fidelity, commercially available bench model using 4-mm polytetrafluoroethylene graft as simulated blood vessel. Two weeks after the tutorial, subjects performed an end-to-side anastomosis in a live porcine model, under realistic operating room conditions. Assessment of outcomes was performed by 2 blinded, expert observers, uings validated measurements of technical skill. The primary outcome was the score on the Objective Structured Assessment of Technical Skill (OSATS) scale. Secondary outcomes included an anastomosis-specific end-product evaluation and time to completion. Statistical analysis was conducted using nonparametric, univariate techniques. RESULTS: Compared with residents who received expert-guided simulator training alone, those who in addition practiced on a simulator independently after hours scored significantly higher on the OSATS scale (23.7 +/- 4.7 vs 18.5 +/- 3.9, P = .003). Residents who practiced independently also scored significantly higher on the end-product evaluation (11.4 +/- 3.2 vs 8.9 +/- 2.1, P = .02) and performed the anastomosis significantly faster (777 seconds vs 977 seconds, P = .04). Interrater reliability was high between the expert observers (intraclass correlation coefficient = 0.8). CONCLUSIONS: Residents who had the opportunity for self-directed simulator practice performed an end-to-side anastomosis more adeptly, more quickly, and with a higher quality end product. The results of this randomized trial suggest that independent training on a procedural trainer did transfer to improved performance in an operating room environment. Simulator training should be incorporated into cardiovascular surgical curricula and residents should have access to this modality for independent after-hours practice to improve operating room performance.
机译：目的：越来越多的证据支持在模拟环境中进行手术技能实践的益处。但是，在心脏外科手术训练中模拟的使用受到限制。本试验的目的是研究在非临床时间内，独立和故意的模拟器实践对体内模型中端对端微血管吻合术的性能的影响。方法：该单盲，随机对照试验获得了机构审查委员会的批准。将39名第一年和第二年的外科手术学员随机分配给程序培训师的专家指导教程，或随机专家在同一程序培训员上结合自我指导的实践。自我指导的练习由在程序训练器上执行的10个吻合组成：一种低保真，市售的台式模型，使用4-mm聚四氟乙烯移植物作为模拟血管。教程开始两周后，在现实的手术室条件下，受试者在活猪模型中进行了端对端吻合。结果的评估是由2位盲目专家观察员进行的，使用了经过验证的技术技能度量。主要结果是对技术技能的目标结构化评估（OSATS）量表的得分。次要结果包括特定于吻合的最终产品评估和完成时间。使用非参数单变量技术进行统计分析。结果：与仅接受专家指导的模拟器培训的居民相比，那些下班后单独在模拟器上练习的居民在OSATS量表上的得分明显更高（23.7 +/- 4.7与18.5 +/- 3.9，P = .003） 。进行独立练习的居民在最终产品评估中的得分也明显更高（11.4 +/- 3.2与8.9 +/- 2.1，P = .02），并且吻合明显更快（777秒vs 977秒，P = .04） 。专家观察员之间的评估者间信度高（类内相关系数= 0.8）。结论：有机会进行自我指导的模拟器练习的居民更熟练，更快速地进行了端到端吻合术，并获得了更高质量的最终产品。这项随机试验的结果表明，对程序培训师的独立培训确实可以改善手术室环境中的表现。模拟器培训应纳入心血管外科课程，居民应在非下班后练习中采用这种方式，以改善手术室性能。

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