Exploration the Standardization Process for Laparoscopy Training in Undergraduate Teaching
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摘要:
目的 探索在本科教学中腹腔镜操作培训的规范化流程。 方法 选取2017年6月至2019年6月在昆明医科大学第一附属医院胃肠与疝外科实习的90名本科实习生，分3期培训，每期30人，培训4周，每期培训30学时。培训内容包括腹腔镜基础理论学习、手术视频学习、体外模拟箱基本技能操作训练（拾豆、缝合打结、动物组织缝合）以及腹腔镜手术虚拟训练系统培训。根据每期学员的反馈意见调整下期课时安排，对比3期不同课时安排下学员理论考核成绩、操作技能考核成绩及学员培训满意度。 结果 3期所有培训学员理论考核成绩均合格，差异无统计学意义（P > 0.05）。学员完成培训后，完成体外模拟箱基本技能操作训练（拾豆、缝合打结、动物组织缝合）操作用时均短于培训前，差异有统计学意义（ P < 0.05）。体外模拟箱基本技能操作训练、腹腔镜手术虚拟训练系统培训分配课时较多学员在第 2、3 期培训后完成拾豆、缝合打结、动物组织缝合用时均短于分配课时少的第1期，差异有统计学意义（ P < 0.05）；第 2、3期学员完成拾豆、缝合打结、动物组织缝合用时比较，差异无统计学意义（ P > 0.05）。培训后反馈结果提示，第3期学员满意度和参与积极性最高。 结论 科学的安排培训时间及培训方法可以提高本科实习医学生的腹腔镜微创技能，具有推广价值。 -
关键词:
- 腹腔镜操作培训 /
- 本科临床教学 /
- 规范化流程 /
- 腹腔镜手术虚拟训练系统
Abstract:Objective To explore the standardization process of laparoscopy operation training in undergraduate teaching. Methods A total of 90 undergraduate interns from the First Affiliated Hospital of Kunming Medical University from January 01, 2017 to June 19, 2019 were selected. They were divided into 3training sessions, 30 people per session, 4 weeks of training and 30 hours of training per session. The training included laparoscopy basic theory learning, surgical video learning, in vitro simulation box basic skills operation training（picking beans, suture knotting, animal tissue suture）and laparoscopy virtual training system training. According to the feedback from trainees in each session, the next class schedule was adjusted. The theoretical assessment scores, performance skills assessment scores and trainee satisfaction of the trainees were compared in the 3 different classes. Results The results of all trainees in the 3 phases were all qualified, and the differences were not statistically significant（P > 0. 05）. After the trainees completed the training, the time to complete the basic skills training（picking beans, suture knotting, animal tissue suture）was all shorter than that before the training, and the differences were statistically significant（ P < 0. 05）. After the trainees with more vitro simulation box basic skill operation training, laparoscopy surgery virtual training system training classes assigned completed the training in the second and third phases, the time to complete picking beans, suture knotting, animal tissue suture was all shorter than that in the first phase fewer classes assigned, and the differences were statistically significant（ P < 0.05）.The time that the trainees in the second and third phases completed picking beans, suturing and knotting and suturing animal tissues was completed, the differences were not statistically significant（all P > 0. 05）.The feedback results after the training indicated that the trainees in the third phase had the highest degree of satisfaction and participation. Conclusion The scientific arrangement of training time and training methods can improve the laparoscopy minimally invasive skills of surgical postgraduates and it has the promotion value. -
表 1 3期腹腔镜技能培训学时分配表
Table 1. Schedule of hours allocated to laparoscopy skills training
内容 第1期学时 第2期学时 第3期学时 基本理论 4 4 4 手术视频 6 2 2 体外模拟箱训练 10 16 14 手术虚拟训练 10 8 10 
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表 2 3 期所有培训学员理论考核成绩结果比较（n）
Table 2. Comparison of the results of theoretical assessment of all trainees in 3 years （n）
分期 n 优秀 合格 不合格 第 1 期 30 14 16 0 第 2 期 30 10 20 0 第 3 期 30 15 15 0
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表 3 3期学员培训前后用时结果比较[（
$\bar x \pm s $ ），s]Table 3. Comparison of the results of pre-training and post-training sessions [（
$\bar x \pm s $ ），s]培训内容 第1期 第2期 第3期 培训前 170.56 ± 26.72 172.22 ± 37.68 176.44 ± 32.81 培训后 67.67 ± 17.03△ 62.89 ± 13.69△▲ 63.00 ± 10.64△▲ 缝合打结 培训前 588.67 ± 100.24 622.42 ± 100.27 581.71 ± 119.97 培训后 158.78 ± 30.32△ 121.44 ± 41.44△▲ 112.87 ± 24.66△▲ 动物组织缝合 培训前 598.56 ± 112.12 579.6 ± 104.57 582.22 ± 120.70 培训后 155.78 ± 38.50△ 116.7 ± 33.08△▲ 100.44 ± 2.67△▲ 与同期培训前比较，△P < 0.05；与第 1 期培训后比较， ▲P < 0.05。
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表 4 学员培训反馈调查
Table 4. Training feedback survey
培训期别 第一期 第二期 第三期 A B C D A B C D A B C D 满意度 8 20 2 0 13 16 1 0 25 5 0 0 参与积极性 9 18 3 0 16 14 0 0 27 3 0 0
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