"六阶法"在儿童消化内镜医师培训中的应用

The application of"six-step method"in the training of pediatric digestive endoscopists

目的由于儿童消化内镜医师及儿童消化内镜规范化培训体系等缺乏,我国儿童消化内镜的发展并不能满足临床需求。且儿童不同于成人,成人的内镜医师培训模式不能照搬至儿童。因此,我中心提出了一种儿童消化内镜医师的培训模式—"六阶法"(即理论教学、手术观摩、模拟器训练、离体动物实验、"手把手"训练及"口把手"训练)。本研究主要探讨"六阶法"在儿童消化内镜医师培训中的应用效果,以进一步完善该培训模式。方法以2018年至2021年在西安市儿童医院进行儿童消化内镜规范化培训的57名学员作为研究对象,通过问卷调研收集学员们对培训模式的满意度评价,内镜技术掌握、内镜技术能力、个人内镜操作情况等。结果(1)学员对培训模式的整体满意度评价为100%。其中,理论教学、手术观摩、"手把手"训练和"口把手"训练各阶段的满意度评价均为100%,模拟器训练及离体动物实验满意度评价分别为97%、96%;(2)培训结束时DOPS形成性评价的分数要优于"手把手"培训2周评价,差异有统计学意义(P<0.05);(3)培训结束时100%的学员可独立行胃镜基础操作(除外13名有胃镜操作基础的学员),96%学员可独立行消化道异物取出术,58%学员可独立行结肠镜操作(除外2名有结肠镜操作基础的学员),20%学员可独立行结直肠息肉内镜下治疗术。此外,个别学员可行食管狭窄球囊扩张术、内镜逆行性阑尾炎治疗术及内镜下置管术;(4)84%学员受训结束后即可在原单位独立开展所掌握的内镜培训技术;(5)85%培训前有操作基础的学员培训后手术并发症发生率较前明显下降。结论"六阶法"培训模式在有限的3~6个月培训时间内具有可靠的教学效果,为儿童消化内镜医师培训走向规范化、专业化、职业化提供了一种有效方式。

Objective Due to the lack of pediatric digestive endoscopists and the lack of training system for pediatric gastroendoscopy,the development of pediatric gastroendoscopy in China is urgent.The training mode"hand and hand"and"mouth and hand"proposed by Chinese digestive endoscopists had some limitation and was incompletely applicable to the training of pediatric digestive endoscopists.Thus,we proposed the"six-step method"(theoretical teaching,surgical observation,simulator training,in vitro animal experiment,"hand over hand"training and"hands-on"training)and achieved preferable effect.In this study,we explored the application effect of"six-step method"in the training of pediatric digestive endoscopist,in order to further improve the training mode.Methods Fifty-seven trainees who received the standardized training of pediatric digestive endoscopist in the Affiliated Children′s Hospital of Xi′an Jiaotong University from 2018 to 2021were enrolled.All of them were trained by pediatric gastroendoscopy based on"six-step method"for 3-6 months.The mastery of endoscopy technology,ability of endoscopy technology,personal operation of endoscopy,satisfaction evaluation of the training mode was collected through questionnaire survey.Results The overall satisfaction evaluation of the trainees to the training mode was 100%.The satisfaction evaluation for theoretical teaching,surgical observation,"hand over hand"training and"hands-on"training were all 100%,the satisfaction evaluation for simulator training and in vitro animal experiment was 97%and 96%,respectively.The score of DOPS formative evaluation at the end of training was better than that of"hand over hand"training for 2 weeks,the difference was statistically significant(P<0.05).100%of the trainees could independently perform the basic operation of gastroscopy(13 trainees with basic gastroscopic operation were excluded),96%of the trainees could independently perform the removal of gastrointestinal foreign bodies,56%of the trainees could independently perform the colonoscopy(2 trainees with basic colonoscopy skills were excluded),and 20%of the trainees could independently perform the endoscopic treatment of colorectal polyps.In addition,balloon dilation of esophageal stenosis,endoscopic retrograde appendicitis therapy and endoscopic catheterization are feasible for individual trainees.In the application of endoscopic technology,84%of the trainees could independently carry out the endoscopic training technology that they mastered in the original unit after the training.Moreover,for the trainees who had basic operation before training,85%of them performed a significant decreased incidence of surgical complications.Conclusion The"six-step method"training mode has a reliable teaching effect in a limited training,and provides an effective way for the standardization,specialization and professionalism of the training of pediatric digestive endoscopists.