视频自我评估在规培医师显微手术自信心和感知能力培养中的作用

Video self-assessment of surgical residents improves confidence and perceptions of basic microsurgical skills

目的:通过规培医师对翼状胬肉切除联合结膜移植术视频录像资料的自我评估,观察规培医师在基本显微手术技能的自信心和感知能力方面的变化。方法:23名规培住院医师和5名指导老师分别对提供的翼状胬肉切除联合结膜移植术视频中基本显微手术技术,进行自我评估。视频分析使用客观结构化的评估表格,分别对术中关键5项技能给予评分。规培医师需在视频自我评估前后,在同样的评估表上完成对自身显微手术技能信心评价;所有参加学员同时完成一份关于这一教学方法的问卷调查。结果:视频评估前后,规培医师自信心方面在5项显微技能总分提高(自我评估前18.87±5.10 vs.自我评估后22.00±3.26,P<0.05),在低年资规培医师表现更明显(自我评估前14.50±4.67 vs.自我评估后21.30±4.37,P<0.05),但在高年资规培医师表现无统计学意义(自我评估前22.23±1.79 vs.自我评估后22.54±2.11,P>0.05)。在对视频中显微手术技能的感知能力方面,规培医师对显微技术评分和指导老师的综合评分差异无统计学意义[学员评估23.0(20.0,25.0)vs.老师评估23.0(23.0,24.5),P>0.05],但在结膜瓣制作方面差异有统计学意义(P<0.05)。问卷调查显示视频评估教学方法受到规培医师的欢迎(赞同率91.3%~100%)。结论:在规培医师(尤其低年资规培医师)自信心培养中,视频自我评估教学模式是一种非常有价值的培训方法,同时也能提升和完善学员对显微手术技能的感知能力。

Objective:To observe the effectiveness of video self-assessment by residents on improving their confidence and perceptions of basic microsurgical skills using the video of pterygium excision combined with conjunctival autograft.Methods:Twenty-three residents and 5 supervisors initially watched the video of pterygium excision combined with conjunctival autograft,and then rated the micro-surgical skills of the operation based on 5 key procedures using an objective structured assessment rubric.All residents were required to complete self-confidence assessment on the five components during operation and following procedures,and supposed to finish the questionnaire on the teaching method.Finally,the data were collected,and subjected to paired Student′s t-test or Rank sum test for statistical analysis.Results:Before and after the video self-assessment,the self-confidence on the 5 micro-skills was significantly improved in the residents(18.87±5.10 for pre-self-assessment vs.22.00±3.26 for post-self-assessment,P<0.05),and the improvement was dominant in junior residents(14.50±4.67 for pre-self-assessment vs.21.30±4.37 for post-self-assessment,P<0.05),yet was insignificant in senior residency(22.23±1.79 for pre-self-assessment vs.22.54±2.11 for post-self-assessment,P>0.05).As far as the perception of microsurgical skills was concerned,the difference remained insignificant in scores from supervisors and residents[supervisor-assessment:23.0(23.0;24.5)vs.resident-assessment:23.0(20.0;25.0),P>0.05],yet there was a slight difference in the conjunctival flap fabrication(P<0.05).Statistics of the questionnaire showed that all residents were favorable to the teaching method using video assessment(91.3%-100%).Conclusion:Video self-assessment can be a valuable teaching model for training of residents,especially in their junior residency,and improve resident confidence and perception of basic microsurgical skills.