模型教学法在经支气管镜高频电圈套术培训中的应用

目的 探讨基于一种支气管镜诊疗模型的综合教学法在经支气管镜高频电圈套术培训中的作用.方法 采用前瞻性自身对照研究,选择20名在第二军医大学长海医院呼吸内镜中心受训的学员作为培训对象,由2名长海医院呼吸内镜专家指导,通过理论知识辅导和模型训练的综合教学法开展经支气管镜高频电圈套操作培训.比较培训前后学员在高频电圈套操作的准确性、流畅度、操作耗时、病灶切除率等方面的差异,并针对培训效果进行问卷调查.结果 20名学员均顺利完成操作培训.与培训前相比,培训后学员经支气管镜高频电圈套切除目标病灶的操作准确性评分由5.73±1.37提高到8.50±0.81,差异有统计学意义(P＜0.01);操作流畅度评分由5.20±1.61提高到8.27±1.00,差异有统计学意义(P＜0.01);操作总耗时由(214.9±112.6)s缩短到(88.1±18.2)s,差异有统计学意义(P=0.01);一次性病灶切除率由(60.0±16.3)％提高到(76.0±12.6)％,差异有统计学意义(P=0.05).对学员的问卷调查结果显示,模型教学法在操作可重复性、仿真度、安全性,以及增加操作稳定性、提高培训效率方面均具有一定优势.结论 采用基于支气管镜诊疗模型的综合教学法开展经支气管镜高频电圈套术的培训,教学效果显著,值得推广.

Application of a simulator-based teaching method in training of bronchoscopic high-frequency electrocautery snare technique

Objective To explore the role of a comprehensive teaching method based on a diagnosis-and-treatment simulator for bronchoscopic procedure in the training of high-frequency electrocautery using snare. Methods A prospective self-control study involved in 20 trainees from the bronchoscopic suit of Changhai Hospital was designed to evaluate the training outcome of bronchoscopic high-frequency electrocautery snare technique . During the training course, theoretical knowledge teaching was followed by simulator-based practice guided by respiratory endoscopic experts from Changhai Hospital. The accuracy and fluency of each trainee in the procedure before and after the training project as well as the operation time and focus on resectability rate by bronchoscopic electrocautery snare were recorded and analyzed. The appraisal of the training effect for each trainee in this study was conducted by questionnaire survey. Results All the 20 trainees successfully completed the whole training project. Data of each trainee before and after training was analyzed. The results showed that after the training the procedure accuracy of excising the target tissue by snare significantly increased from 5.73 ± 1.37 to 8.5 ± 0.81 (P <0.001 vs. that before the training). The fluency of operating snare improved from 5.2 ± 1.61 before the training to 8.27 ± 1.0 after the training (P <0.001). Total time-consuming shortened significantly from (214.9 ± 112.6) s to (88.1 ± 18.19) s after the training (P = 0.002). Target tissue excision rate increased significantly from (60.0 ± 16.32)% to (76.0 ± 12.64)% after the training(P = 0.025). The questionaire survey showed that all the trainees benefited from the comprehensive simulator-based teaching method. There are several advantages in this teaching method, such as operation repeatability, high model simulation degree, safety ,stability and improved training efficiency. Conclusion The outcomes of the simulator-based comprehensive teaching method in bronchoscopic electrocautery snare technique training were distinct. This teaching method was worthy to be promoted in bronchoscopic trainings.