培训的培训者在内镜黏膜下剥离术培训中的应用

The effect of train the trainer profile in ESD training

目的探讨培训的培训者(train the trainer,TTT)培训模式在内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)模拟培训中的效果。方法以6位受训者(内镜操作≥500例,无ESD操作经验)为研究对象,由培训者(ESD专家,人体ESD操作≥100例次)对受训者首先进行理论培训,然后应用离体猪胃模型进行第1轮的手把手初级培训;在后续轮次培训中,每一位受训者担任培训者,指导其他受训者完成ESD操作(角色转换)。通过比较受训者培训前后的总操作时间、环切时间、黏膜下剥离时间并记录病变是否完整切除、穿孔并发症,评价TTT培训模式提高受训者操作水平的作用。结果 6位受训者接受5轮次培训,完成30处病变模拟ESD操作,操作时间明显缩短,总操作时间、环切时间、黏膜下剥离时间分别从(37.33±5.85)min、(12.83±2.93)min、(24.50±3.39)min缩短到(24.50±4.59)min、(7.33±1.63)min、(13.00±3.58)min;其中未完整切除标本4例、穿孔1例,均发生在培训的前3轮次。通过观察受训者的学习曲线发现,受训者ESD操作时间逐渐缩短,第4轮次与培训以后的操作时间比较,无明显差异(P>0.05)。结论 TTT培训模式,通过角色转换促进受训者的主动学习,经过4轮次培训达到离体猪胃模拟ESD操作的技术稳定和操作时间稳定。该培训模式值得进一步扩大研究和推广。

Objective To evaluate the effect of train the trainer profile in ESD simulated training.Methods Six endoscopists with no ESD experience were included.They firstly received didactic material and theoretical aspects of ESD.Then,they underwent the training program using an ex-vivo animal(swine)model(esophagus-stomach)stimulating the human body ESD procedure.During the following training sequences,the previous trainee acted as an assistant and stimulated the“trainer”to train the next trainee(role transition).We accessed the efficacy of TTT on raising operation level of trainee by comparing the time for total operation,time for mark lesions,time for circumferential incision and recording the en-bloc resection rate and the ESD-related perforation.Results Six trainees received 5 rounds TTT training,performed a total of 30 simulation ESD operation in ex-vivo model.The operation time was shortened obviously.The total operating time,circumferential incision time,time for submucosal dissection respectively decreased from(37.33±5.85)min,(12.83±2.93)min,(24.50±3.39)min to(24.50±4.59)min,(7.33±1.63)min,(13.00±3.58)min.Uncomplete resection was achieved in 4 cases and with 1 case of perforation recorded,all occured in the first 3 rounds of training.As showed in the learning curve of the trainee,the duration of ESD operation was shortened and there was no significant difference in operation time after the 4 rounds of training(P>0.05).Conclusions TTT training profile is feasible and effective to improve the active learning by role conversion.The operation time were stable after 4 rounds training.However,further study is needed for the in-vivo animal/swine model ESD training.