形成性评估在外科医师非手术定向腹腔镜模拟训练中的应用

Application of the formative assessment in nonprocedural laparoscopic simulating training for surgeons

目的在不同年资外科医师非手术定向腹腔镜模拟训练中，探讨形成性评估应用的可行性及意义。方法选取北京大学第三医院泌尿外科55名不同年资外科医师为研究对象，含外科进修医师42人和专业学位研究生13人。对他们进行连续4周的非手术定向腹腔镜模拟训练，实验组29名医师采用形成性评估，对照组26名医师采用终结性评估，分别对其培训前后的操作进行量化评分和统计分析。结果所有医师在培训后操作评分均有明显上升，进修医师的缝合打结提升幅度显著高于研究生，且差异具有统计学意义[（17.1±2.9）vs（14.2±3.5），t＝2.97，P＝0.004]。研究生中，培训后实验组的基础操作考核成绩更高且差异具有统计学意义[（12.6±0.8）vs（9.0±0.6），t＝－8.91，P＝0.000]；进修医师中，培训后实验组的缝合打结成绩更高且差异具有统计学意义[（35.2±2.5）vs（33.0±2.5），t＝－2.83，P＝0.007]。形成性评估中研究生与进修医师的成绩变化曲线存在差异。结论非手术定向腹腔镜模拟训练对不同年资外科医师均可行，可以提高腹腔镜操作水平，外科学研究生与外科进修医师培训效果存在差异。在腹腔镜模拟培训中应用形成性评估，对于提高各年资外科医师的培训效果均有积极意义。

Objective To explore the feasibility and effect of the application of the formative assessment in nonprocedural laparoscopic simulating training for surgeons in different seniorities.Methods A total of 55 surgeons in different seniorities were selected from Peking University Third Hospital as research object, including 42 refresher doctors on surgery and 13 graduate students on surgery for master degree. For them, a 4-week nonprocedural laparoscopic simulating training was carried out, in which the formative assessment was set up for 29 trainees as experimental group, and the summative assessment for the other 26 trainees as control group. The laparoscopic skills before and after training were evaluated in scores and compared statistically in both groups.Results All trainees had higher laparoscopic skills post-test scores than their pretest’s, but the enhancement in suturing and knotting test for refresher doctors （17.1±2.9） was statistically higher than that for graduate students（14.2±3.5）（t=2.97, P=0.004）. In graduate students, statistically higher scores in the basic skills post-test was obtained in experimental group[（12.6±0.8）vs（9.0±0.6）, t =-8.91, P =0.000]. In refresher doctors, statistically higher scores in suturing-knotting post-test was obtained in experimental group[（35.2±2.5）vs（33.0±2.5）, t=-2.83, P=0.007]. Formative assessment showed different trends in the curves of skill enhancement between surgical refresher doctors and graduate students.Conclusions Nonprocedural laparoscopic simulating training can feasibly improve laparoscopic skills, with variety between surgical refresher doctors and graduate students. Formative assessment is an effective method for surgeons in different seniorities during laparoscopic simulating training.