目的:基于能力的教育要求使用精确的术中评估工具。我们旨在定义专家认为对评估至关重要的基于共识的开放式手术技能。
方法:采用混合方法设计:系统评价和e-Delphi方法。
方法:这项研究是在蒙特利尔的麦吉尔大学附属大型高等教育中心进行的,魁北克,加拿大。
方法:根据PRISMA指南,采用了同行评审的搜索策略.包括以英语发表的研究和描述开腹手术技术技能评估的研究;亚专业特定技能,会议摘要,学术回忆录被排除在外。引用最多的技能采用电子德尔福方法,以确定专家认为必不可少的技能,基于李克特的三分量表。18名麦吉尔大学附属普通外科医生,代表普外科的各种亚专科,被邀请回答问卷。
结果:4285个参考中的约120个被保留用于分析。引用最多的12种技能包括缝合,组织和仪器处理,运动经济,仪器知识,打结,流量,程序知识,完成时间,解剖技术,解剖学和无菌技术知识;经过2轮调查,其中6个获得了很高或完美的分数和一致性:缝合,无菌技术,打结,解剖学知识,程序知识,和组织处理。中值标准偏差从第一轮到第二轮下降(0.495到0.450),表明共识有所改善。
结论:这些结果将有助于开发和验证OSCAR(客观结构化临床评估标准)评估工具,以便为手术学员提供开放技术技能的术中即时反馈。
OBJECTIVE: Competency-based education has mandated accurate intra-operative assessment tools. We aimed to define
consensus-based open surgical skills perceived by experts as critical for assessment.
METHODS: A mixed-method design was employed: systematic review and e-Delphi methodology.
METHODS: The study was performed at McGill University-affiliated large tertiary academic centers in Montreal, Quebec, Canada.
METHODS: Per PRISMA
guidelines, a peer-reviewed search strategy was employed. Studies published in English and those describing technical skill assessment of open abdominal surgery were included; subspecialty-specific skills, conference abstracts, academic memoirs were excluded. Most-cited skills were subjected to e-Delphi methodology to identify those deemed essential by experts, based a 3-point Likert scale. Eighteen McGill University-affiliated general surgeons, representing a variety of subspecialties of General Surgery, were invited to answer the questionnaire.
RESULTS: Around 120 of 4285 references were retained for analysis. The 12 most cited skills included suturing, tissue and instrument handling, movement economy, instrument knowledge, knot tying, flow, knowledge of procedure, completion time, dissection technique, knowledge of anatomy and sterile technique; 6 of these achieved high or perfect scores and agreement after 2 rounds of survey: suturing, sterile technique, knot tying, knowledge of anatomy, knowledge of procedure, and tissue handling. Median standard deviation decreased (0.495 to 0.450) from first to second round, indicating improvement in
consensus.
CONCLUSIONS: These results will help develop and validate the OSCAR (objective structured clinical assessment rubric) assessment tool for immediate intra-operative feedback of open technical skills for surgical trainees.