背景:手术室不再是心胸外科住院医师进行早期手术培训的理想场所,强制搜索基于模拟的学习选项。这项研究的目的是在便携式冠状动脉吻合术的构建和手术训练,低成本,自制模拟器。
方法:这是一个观察性的,分析,和多中心研究。模拟器是用普通材料建造的,并通过修改的客观结构化技术技能评估(或OSATS)进行评估。来自9个国家心胸外科中心的所有初级和高级居民均被考虑90天。操作技能获取和创建并排(S-T-S)的时间,端对端(E-T-S),和端到端(E-T-E)冠状动脉吻合术进行评估。在两个时间段内,由一名高级心胸外科医生记录并评估所有会话。
结果:在270个疗程中评估了140名居民。在初级居民中,在S-T-S中确定了最终分数的显着改善(使用Castroviejo针架,针角,和针头转移)(P<0.05)。在老年人中,在S-T-S(移植物取向,适当的间距,使用镊子,angles,和针转移)吻合(P<0.05)。在S-T-S中确定了高级居民比初级居民的最终吻合时间显着改善(8.11vs.11.22分钟),E-T-S(7.93vs.10.10分钟),和E-T-E(6.56vs.9.68分钟)(P=0.039)。
结论:我们的便携式低成本冠状动脉吻合模拟器可有效提高心胸外科住院医师的手术技能;因此,通过基于模拟的培训转移获得的技能对手术环境有积极影响。
BACKGROUND: The operating room is no longer the ideal place for early surgica training of cardiothoracic surgery residents, forcing the search for simulation-based learning options. The study\'s aim was the construction and surgicaltraining of coronary anastomosis in a portable, low-cost, homemade simulator.
METHODS: This is an observational, analytical, and multicenter study. The simulator was built with common materials and was evaluated with the Objective Structured Assessment ofTechnical Skills (or OSATS) Modified. All junior and senior residents from nine national cardiothoracic surgery centers were considered for 90 days. Operative skill acquisition and time in the creation of side-to-side (S-T-S), end-to-side (E-T-S), and end-to-end (E-T-E) coronary anastomoses were evaluated. All sessions were recorded and evaluated by a single senior cardiothoracic surgeon during two time periods.
RESULTS: One hundred and forty residents were assessed in 270 sessions. In junior residents, a significant improvement in final scores was identified in S-T-S (use of Castroviejo needle holder, needle angles, and needle transfer) (P<0.05). In seniors, a significant improvement was identified in S-T-S (graft orientation, appropriate spacing, use of forceps, angles, and needle transfer) anastomoses (P<0.05). A significant improvement in the final anastomosis time of senior residents over junior residents was identified in S-T-S (8.11 vs. 11.22 minutes), E-T-S (7.93 vs. 10.10 minutes), and E-T-E (6.56 vs. 9.68 minutes) (P=0.039).
CONCLUSIONS: Our portable and low-cost coronary anastomosis simulator is effective in improving operative skills in cardiothoracic surgery residents; therefore, skills acquired through simulation-based training transfer have a positive impact on the surgical environment.