阶梯式手术培训模式在输尿管软镜教学中的应用

目的介绍我中心阶梯式手术培训模式在输尿管软镜教学的初步探索经验。 方法根据随机数字表的方式，将2015年5月至2018年5月期间，在南昌大学第四附属医院进修并接受输尿管软镜培训的泌尿外科医师随机分为阶梯式培训组和传统教学组，每组学员各20名。传统培训模式学员，直接进入临床培训阶段；阶梯式培训模式在学员进入临床培训前，需经过理论学习、体外训练、动物操作三个阶段。学员在前一阶段的学习后，经过考核方可进入下一阶段培训。 结果两组学员年龄、学历、职称及有无输尿管镜手术经验上差异无统计学意义。通过系统培训，两组共40名成员均可在导师指导下独立完成输尿管软镜手术。两组学员治疗结石患者年龄、性别及结石负荷差异无统计学意义。手术培训时间（月）、手术培训例数（例），首例独立完成手术时间和学员评分四项指标差异有统计学意义。术中未发生结石移位，无输尿管穿孔，无结石残留。阶梯培训组，术后并发泌尿系感染1例，给与常规抗感染治疗后好转。 结论通过输尿管软镜碎石术的阶梯式培训模式，可以缩短手术培训时间，减少手术培训例数，降低首例手术时间，增加学员评分。

The application of stepped trainning mode in the teaching of flexible ureteroscopic lithotripsy

ObjectiveTo introduce the preliminary experience of the application of ladder-type operation training mode in flexible ureteroscope teaching. MethodsThe urologists who received advanced studied and flexible ureteroscope training in the Fourth Affiliated Hospital of Nanchang University's from May 2015 to May 2018 were randomly divided into the ladder-type training group (n=20) and traditional training group (n=20). In the traditional training group, the urologists were directly subject to clinical training. In the ladder-type training group, the urologists had to receive theoretical study, in vitro training and animal operation prior to clinical training. They could proceed into the next stage of training only after passing the examination of the previous session. ResultsAge, educational level, professional title and experience of ureteroscopy did not significantly differ between two groups. Through systematic training, 40 urologists could independently complete the procedures of ureteroscopy under the guidance of their instructors. Age, gender and stone load did not significantly differ between two groups. The operation training time (month) and the number of operation training case, the first independent operation time and the scores of training urologists significantly differed between two groups. Intraoperatively, no stone displacement, ureteral perforation or residual stone was observed. In the ladder-type training group, one patient was complicated with urinary tract infection after surgery, which was mitigated after routine anti-infection therapy. ConclusionApplication of the ladder-type training mode in flexible ureteroscopic lithotripsy can shorten the operation training time, reduce the number of operation training cases, shorten the first independent operation time and enhance the scores of training urologists.