背景:陪伴和简单的经验或幼稚的实践(NP)很少导致专家级手术,与故意练习(DP)相反,在DP中,专家分析学习者的错误并设定目标以提高绩效。主要假设是使用DP进行学习将导致比使用NP更快和/或更大的进步。
目的:这项工作的目的是比较在锁骨骨折的锯骨模型上放置锁骨锁定钢板的学习曲线的演变,由外科学员通过两种不同的方法学习;NP和DP。
方法:10名手术住院医师,分成2组5个,每组放置6个平板。拍摄了6次试验。NP小组在每次放置之前都看到了专家视频。DP小组看过此视频一次,然后收到专家的个性化建议进行改进,通过在每次后续试验后分析他们自己的视频。客观绩效(OP)是通过标准化评估网格(OSATS,每次试验得分为10到50分),通过数值量表(从0到10)对性能进行自我评估,并通过镇痛-伤害感受指数对压力进行自我评估(ANI,通过心率记录计算,从0到100)。
结果:锁骨板放置的最后一次试验的平均OP为41.8(NP组)和48.2(DP组),NP组从第一次到最后一次试验的平均进展为0.8,和5.1在DP组中。第一次和最后一次试验之间自我评估的平均进展为3.4(NP组)和4.6(DP组)。第一次和最后一次试验之间的ANI平均进展为-4.5(NP组)和+5(DP组)。
结论:通过OSATS测量的学习锁骨钢板接骨技术的结果通过刻意练习比幼稚练习更好。经过深思熟虑的练习,自我评估的表现进展更好,但是压力水平更高。
结论:刻意练习是一种学习外科手术的技术,它补充了陪伴和经验。它缩短了学习曲线,提高了手术学员的表现水平。
方法:IV;非干预性研究。
BACKGROUND: Companionship and simple experience or naive practice (NP) rarely lead to expert level surgery, in contrast to deliberate practice (DP) where an expert analyzes the learner\'s errors and sets goals to improve performance. The main hypothesis was that using DP for learning would result in faster and/or greater progress than using NP.
OBJECTIVE: The objective of this work was to compare the evolution of the learning curve for clavicle locking plate placement on a sawbone model of a clavicle fracture, by surgical trainees learning via two different methods; NP and DP.
METHODS: Ten surgical residents, divided into 2 groups of 5, each placed 6 plates. The 6 trials were filmed. The NP group saw an expert video before each placement. The DP group saw this video once and then received personalized advice from the expert for improvement, by analyzing their own video after each subsequent trial. Objective performance (OP) was measured by a standardized evaluation grid (OSATS, with a score ranging from 10 to 50 points per trial), self-evaluation of performance by a numerical scale (from 0 to 10) and stress by an analgesia-nociception index (ANI, calculated by heart rate recording, from 0 to 100).
RESULTS: The mean OP at the last trial of clavicle plate placement was 41.8 (NP group) and 48.2 (DP group), with a mean progression from the first to last trials of 0.8 in the NP group, and 5.1 in the DP group. The mean progression in self-evaluation between the first and last trials was 3.4 (NP group) and 4.6 (DP group). The mean progression of the ANI between the first and last trials was -4.5 (NP group) and +5 (DP group).
CONCLUSIONS: The results of learning a clavicle plate osteosynthesis technique measured by OSATS were better with deliberate practice than with naive practice. The progression in self-evaluated performance was better with deliberate practice, but with a higher stress level.
CONCLUSIONS: Deliberate practice is a technique for learning the surgical procedure which complements companionship and experience. It shortens the learning curve and improves the level of performance of surgical trainees.
METHODS: IV; non-interventional research.