视频辅助Debriefing教学法在外科住院医师腹腔镜技能培训中的应用与评价

目的:探索视频辅助Debriefing(VAD)在外科住院医师腹腔镜模拟教学中的应用效果。方法:选取2016年8月至2018年8月规培的40名学员及5名带教老师作为研究对象。将学员随机分为对照组(n=20)与实验组(n=20),完成各阶段腹腔镜体外模拟训练内容后分别予以常规口述式Debriefing与VAD。比较两组学员完成各操作的效率;学员及教师利用DASH评分表分别对VAD进行质量评价;调查学员与教师对课程的整体满意度、教学体验。结果:实验组3 min内传运豆子的数量多于对照组(14.20±2.67)颗vs.(12.40±2.85)颗,P<0.05];实验组完成一组缝合打结用时少于对照组(89.20±13.90)s vs.(101.40±14.16)s,P<0.05];实验组完成腹腔镜胆囊三角模拟解剖时间少于对照组(18.57±2.41)min vs.(21.61±3.75)min,P<0.05];实验组与对照组操作过程中出现小失误的频率为15%vs.45%(χ2=4.792,P=0.0286)。学员DASH评分普遍高于教师,其中学员与教师对“组织Debriefing具有条理性”这一条均给出了最低分。结论:VAD教学模式能有效提高低年资外科医师的腹腔镜模拟技能培训效率,减少操作失误或因失误引发的不良事件。

The application and evaluation of video-assisted debriefing in laparoscopic-skill training for surgical residents

Objective:To evaluate the role and significance of video-assisted debriefing(VAD)in laparoscopic-skill training for surgical residents.Methods:Forty surgical residents who were enrolled in the standardized residents training program from Aug.2016 to Aug.2018,as well as 5 instructors,were chosen as the study objectives to investigate the training experience.The trainees,who were randomly divided into control group(n=20)and VAD group(n=20),accepted laparoscopic simulation training course followed by different kind of debriefing after each section.The control group conducted the oral debriefing as usual while the VAD group conducted the VAD.The differences in laparoscopic skills obtaining between two groups were compared and the debriefing assessment for simulation in healthcare(DASH)was used to evaluate the effect of VAD from trainees and instructors after the simulation training.Results:Within 3 min,more beans were transferred by VAD group as compared with control group in the training section of passing beans(14.20±2.67)vs.(12.40±2.85),P<0.05].Also,the time needed for VAD group to finish a set of suture&knot(89.20±13.90)s vs.(101.40±14.16)s,P<0.05]and dissection of Calot triangle on a simulator(18.57±2.41)min vs.(21.61±3.75)min,P<0.05]was significantly less than the control group did,respectively.Besides,the occurrence of minor technical errors in VAD group was much less than control group(15%vs.45%,χ2=4.792,P=0.0286).The average DASH score from trainees was generally higher than that from the instructors.With consistent score,the element“structures the debriefing in an organized way”was graded the lowest by both trainees and instructors.Conclusions:Comparing with the traditional teaching method,the VAD model would effectively promote the efficiency of laparoscopic-skills training for young surgical residents.