以小梁切除术为例探讨住院医师内眼手术显微操作培训的策略

Exploring the training strategies of the intraocular microsurgical operations among residents with trabeculectomy as an example

目的 以小梁切除术为例探讨内眼显微手术操作培训的策略。方法 针对目前国内住院医师内眼显微手术操作培训的困境,结合国外住院医师小梁切除术的培训结果和小梁切除术的技术选择,包括虚拟模拟器和常用的猪眼模型,探讨以Kolb理论为主的手术训练有效性的理论基础,以及评估手术熟练程度和实际技能能力的眼科手术能力评估量表(ophthalmology surgical competency assessment rubrics, OSCARS)。结果 在指导医师监督下由住院医师进行小梁切除术完全合格。在小梁切除术的技术选择中,Moorfields手术安全系统的学习方法受到推荐。OSCARS对评估内眼显微操作的能力和程度具有积极意义。结论 小梁切除术是住院医师学习内眼显微手术起步的理想选择。手术培训的理论基础,包括计算机仿真模拟技术的学习平台和OSCARS是内眼显微手术操作培训的重要策略。

Objective To explore the strategies in the training of intraocular microsurgery taking trabeculectomy as an example. Methods According to the current dilemma in the training of intraocular ophthalmic microsurgery for domestic residents, combined with the training results of foreign residents on trabeculectomy and possible technical options for trabeculectomy, including virtual simulators and commonly used pig eye models,the theoretical basis for the effectiveness of surgical training based on Kolb theory was explored, as well the Ophthalmology Surgical Competency Assessment Rubrics(OSCARS), which assesses surgical proficiency and practical skills. Results The trabeculectomy performed by residents under the supervision of the guiding surgeons was completely qualified. Among the technical options of trabeculectomy, the learning method of the Moorfields surgical safety system was recommended. The OSCARS possessed a positive significance in assessing the ability and extent of intraocular micro-manipulation. Conclusion Trabeculectomy can be referred to as an ideal start for residents learning intraocular microsurgery. The theoretical basis of surgical training, the learning platform based on computer simulation technology, and the OSCARS can be supposed as the important strategies for training intraocular microsurgery operations.