系统化模拟培训模式在软性输尿管镜培训中的应用

Application of systematic simulation training program in flexible ureteroscopy training

目的评估系统化模拟训练模式在软性输尿管镜培训中的应用价值。方法将培训课程分解为软性输尿管镜移位定位操作、套石篮抓取结石以及使用钬激光碎石3个部分。前瞻性选择我院2017年3月软性输尿管镜培训班学员30名,并将其随机分为2组:规范化系统训练组和自主练习组,每组15名。规范化系统训练组学员利用体外培训干式模拟器,严格按照培训课程内容和形式逐一完成3个部分的训练内容,每个训练部分操作学习60 min。自主练习组学员利用体外培训干式模拟器自主操作学习180 min。完成训练后,分别对两组学员在体外培训干式模拟器和猪动物手术下进行考核,考核项目包括动物手术集合系统软性输尿管镜移位定位和干式模拟器下软性输尿管镜移位定位、套石篮抓取结石、钬激光碎石。记录并比较两组学员的操作时长以及导师对操作情况的整体评价量表(GRS)评分。结果规范化系统训练组学员在动物手术下软性输尿管镜移位定位和干式模拟器下软性输尿管镜移位定位、套石篮抓取结石、钬激光碎石考核中的操作时长均短于自主练习组学员,差异均有统计学意义(P均<0.05);规范化系统训练组学员考核中导师对各考核项目操作的GRS评分均优于自主练习组学员,差异亦均有统计学意义(P均<0.05)。结论系统化模拟训练模式模块化分解了软性输尿管镜学习过程,提高了学员的学习效率和积极性,有助于学员快速掌握软性输尿管镜的操作技巧,缩短了学习曲线。

Objective To evaluate the value of systematic simulation training program in the training of flexible ureteroscopy. Methods The training course was divided into three parts： shifting and positioning of flexible ureteroscope, stone-grasping with basket and lithotripsy by holmium laser. Thirty trainees in the flexible ureteroscopy training class in our hospital in March 2017 were prospectively selected and divided into 2 groups： standardized systematic training group and autonomous training group, with 15 trainees in each group. The trainees in the standardized systematic training group gradually completed the training contents of the three parts in strict accordance with the contents and forms of the training courses using in vitro training dry simulator, spending 60 min in each course, while the trainees in the autonomous training group completed the training by self-study using in vitro training dry simulator for 180 min. After completing the training, the trainees in the two groups were assessed by the in vitro training dry simulator and pig animal surgery, and the examination items included the shifting and positioning of the flexible ureteroscope in the animal surgery system or the dry simulator, stone-grasping with basket, and lithotripsy by holmium laser. The operating time and global rating scale（GRS） score for the operation by tutor were compared between the two groups. Results The operating time for the shifting and positioning of the flexible ureteroscope in the animal surgery system or the dry simulator, stone-grasping with basket, and lithotripsy by holmium laser in the standardized systematic training group were significantly shorter than those in the autonomous training group（all P〈0.05）. The GRS scores for the above operations in the standardized systematic training group were higher than those in the autonomous training group（all P〈0.05）. Conclusion The systematic simulation training program divides the flexible ureteroscopy training course into three separate parts, improves the learning efficiency and enthusiasm of the trainees, helps the trainees quickly mastering the operation skills of flexible ureteroscopy, and shortens the learning curve.