背景:通过模拟课程和术中经验,越来越重视受训者机器人手术技能的发展。然而,很少有研究研究控制台案例类型如何影响学习成果。我们试图根据使用单控制台机器人和双控制台机器人来评估术中指导和居民自主权的差异。
方法:包括2023年2月至9月在单一机构的机器人单控制台和双控制台案例。教职员工和学员在案件中佩戴麦克风以捕获音频。进行了前/后调查,其中包括基于威斯康星州外科教练规则(WiSCoR)的教师教练指标和基于机器人技能全球评估评估(GEARS)的受训者技术表现指标。采用SPSS对调查数据进行统计分析。2名研究人员使用WiSCoR作为框架,采用演绎方法对案例中的音频进行编码。
结果:收集了来自4个外科专业的9个病例类型的7个(38.9%)单和11个(61.1%)双控制台病例的数据。卡方分析表明,根据受训者级别或控制台案例类型,在手术外科医生角色中花费的案例受训者百分比没有显着差异。独立t检验显示,受训人员自主性无显著差异,见习表演,或基于控制台案例类型的教师指导分数。学员在WiSCoR领域1(分担责任)和3(提供建设性反馈)中对教师的评价最高。定性分析表明,对于单控制台案例,领域4(目标设置)代表最多(占评论的34.0%),而对于双控制台案例,域1代表最多(占注释的37.0%)。
结论:定性分析强调,尽管各领域基于调查的教师评级相似,关于自我反思(领域2)的教练很少做,强调在机器人手术期间教练这方面的改进机会。
BACKGROUND: A growing importance has been placed on development of trainee robotic surgical skills through simulation curricula and intraoperative experience. However, few studies have examined how console case type impacts learning outcomes. We sought to evaluate how intraoperative
coaching and resident autonomy differ based on the use of a single- versus dual-console robot.
METHODS: Robotic single- and dual-console cases from February to September 2023 at a single institution were included. Faculty and trainees wore microphones to capture audio during the case. Pre/post surveys were administered, which included metrics on faculty
coaching based on the Wisconsin Surgical
Coaching Rubric (WiSCoR) and on trainee technical performance based on the Global Evaluative Assessment of Robotic Skills (GEARS). Statistical analysis of survey data was performed using SPSS. Audio from cases was coded by 2 researchers with a deductive approach using WiSCoR as a framework.
RESULTS: Data were collected for 7 (38.9%) single and 11 (61.1%) dual-console cases across 9 case types from 4 surgical specialties. Chi-square analysis demonstrated no significant difference in percentage of case trainee spent in the operating surgeon role based on trainee level or console case type. Independent t-tests showed no significant difference in trainee autonomy, trainee performance, or faculty
coaching scores based on console case type. Trainees rated faculty highest in WiSCoR Domains 1 (sharing responsibility) and 3 (providing constructive feedback). Qualitative analysis showed that for single-console cases, Domain 4 (goal setting) was most represented (34.0% of comments), while for dual-console cases, Domain 1 was most represented (37.0% of comments).
CONCLUSIONS: Qualitative analysis highlights that despite similar survey-based faculty ratings across domains,
coaching on self-reflection (Domain 2) is infrequently done, highlighting an opportunity for improvement in this area of coaching during robotic surgery.