目的:评估结构模拟课程对产科肛门括约肌损伤(OASIS)修复的短期和技能保留效果。
方法:本实验研究招募了北京协和医院31名妇产科住院医师。OASIS维修技能评估(在所有时间点)包括任务特定清单(TSC),全球评级量表(GRS),和通过/失败等级。仿真课程采用了牛舌模型。基线测试后,居民完成了一个结构化的1-h工作坊。两周后,进行了第二次测试,接着是一对一的教学研讨会,以正确完成清单为终点。三个月后,居民完成了第三次测试。
结果:基线时的总体通过率为16.1%,老年居民的GRS评分较高(p=0.035)。此外,课前预习手术和OASIS修复观察史与较高的TSC和GRS评分相关.在第二次和第三次测试中观察到显著的技能改进,合格率分别为96.8%和93.5%。与基线相比,TSC和GRS评分均有所改善(p<0.001)。
结论:在监督下整合刻意练习的结构模拟课程提高了OASIS修复能力,并实现了令人满意的技能保留。
OBJECTIVE: To assess the short-term and skill-retention effects of a structural simulation curriculum for the repair of obstetrical anal sphincter injuries (OASIS).
METHODS: This prepost experimental study recruited 31 obstetrics and gynecology residents from Peking Union Medical College Hospital. OASIS repair skill evaluations (at all timepoints) comprised a task-specific checklist (TSC), global rating scale (GRS), and pass/fail grade. A beef-tongue model was adopted in the simulation curriculum. After baseline testing, residents completed a structured 1-h workshop. Two weeks later, a second test was performed, followed by a one-to-one teaching workshop, with the proper completion of a checklist as the end-point. Three months later, residents completed a third test.
RESULTS: The overall pass rate at baseline was 16.1%, with higher GRS scores (p = 0.035) in senior residents. Additionally, previewing the procedure before class and a history of OASIS repair observation were associated with higher TSC and GRS scores. Significant skill improvement was observed in the second and third tests, with pass rates of 96.8% and 93.5% respectively. Both TSC and GRS scores were improved compared with baseline (p < 0.001).
CONCLUSIONS: A structural simulation curriculum integrating deliberate practice under supervision improves OASIS repair competence and achieves satisfactory skill retention.