基于经尿道手术模拟器的系统培训在泌尿外科膀胱镜操作临床教学中的应用

Application of a virtual reality transurethral simulator in clinical teaching for cystoscopy

目的评价基于经尿道手术模拟器培训是否有助于提高新手泌尿外科膀胱镜临床操作水平。方法选择在上海交通大学医学院附属瑞金医院外科类专业住院医师规范化培训基地接受培训的住院医师(简称外科类基地组)15人、泌尿外科医学硕士专业学位研究生(简称专硕组)6人、低年资泌尿外科医师(简称低年资组)6人为研究对象,采用系统教学方法进行培训。培训完成后在模拟器上进行操作考核,通过模拟器考核者在上级医师指导下完成真实病例临床膀胱镜考核。收集操作时长、考官评分、损伤和出血情况相关数据,采用配对t检验(正态分布)或Wilcoxon符号秩和检验(非正态分布)进行统计学分析。结果培训后所有人都一次性通过模拟器考核,观察完整性均为100%。培训前后临床膀胱镜操作考核结果分析表明,专硕组经过系统培训后,操作时长缩短(t=10.0074,P=0.0002)、损伤出血次数降低(t=2.7116,P=0.0422)、考官评分提高(t=-3.285,P=0.0218),差异有统计学意义。低年资组虽然培训前后操作时长和损伤出血次数的差异无统计学意义,但考官评分提高(t=-3.9967,P=0.0104),差异有统计学意义。外科类基地组经过培训后均能在上级医师指导下完成临床膀胱镜操作,操作时长(792.00±65.92)s,考官评分(83.87±5.18)分,损伤出血次数(0.93±0.80)次。结论基于模拟器的系统膀胱镜教学对于零基础的初学者以及具有一定基础的医师都有较好的学习效果,在教学活动中具备有效性和可操作性。

Objective To evaluate whether virtual reality transurethral simulator-based sytematic training can improve the clinical performance of cystoscopy in junior surgeons.Methods A total of 27 cases were enrolled in this study,including 15 surgical residents in standardized training program,6 urological postgraduates,6 junior urdogists.All of them received systematic teaching method of centralized teaching and simulator operation training.An examination was performed based on the simulator.The examiners scored based on the performance of the students and some of the objective data collected by the simulator.Those who passed the test on simulator received the further assessment of clinical cystoscopy in real cases under the guidance of a supervisor.The operation time,examiner’s score,injury and bleeding times were collected.The paired t test or Wilcoxon signed rank test were used for statistical analysis.Results All of them passed the simulator assessment after the training with 100%completeness of observation.In the postgraduate group,the operation time was shortened(t=10.0074,P=0.0002),the injury and bleeding times were reduced(t=2.7116,P=0.0422),and the examiner’s score was improved(t=-3.285,P=0.0218)after systematic training with statistical significance.In the junior urologist group,although no statistically significance was observed in the operation time and the injury,and bleeding before and after training,the examiner’s score was significantly improved(t=-3.9967,P=0.0104).After the systemic training,15 surgical residents in standardized training program could complete clinical cystoscopy under the guidance of a supervisor.The operation time was(792.00±65.92)s,the examiner’s score was(83.87±5.18)points,and the injury and bleeding were(0.93±0.80)times.Conclusion The systematic teaching based on virtual reality transurethral simulator was effective on both zero-based beginners and students with a certain foundation,which might be a useful educational method for cystoscopy.