Residency training for minimally invasive surgery

ABSTRACT Objective: to develop a training program in minimally invasive surgery, based on simulation and with an emphasis on the acquisition of laparoscopic competences. Methods: this was a prospective, observational study carried out at a university hospital in Belo Horizonte, Brazil, between April 2020 and January 2021. We recruited residents of surgical specialties for structured, progressive training according to instructional principles to promote learning, such as motivation, activation, demonstration, application, and integration. We filmed the skill tests at the program’s beginning, middle, and end, which were then anonymously evaluated by a surgical education expert. Individual performances were scored using the global assessment tools “GOALS” and “specific checklist for suture”. At the end, all participants received individual feedback and completed a questionnaire to assess the impact of training on the Kirkpatrick model. Results: 43 residents completed the program. The evolution of performances was evident and grew between tests. The average achievements were 29% in the initial test, 43% in the intermediate test, and 88% in the final test, with significant differences between all mean scores, with H=97.59, GL=2, p<0.0001. The program evaluation and learning perceptions were excellent, but only 10.7% of residents felt fully capable of performing unsupervised, low-complexity laparoscopic surgery at the end of training. Conclusions: the training program developed in this study proved to be feasible and promising as a strategy for teaching laparoscopic surgery.摘要 研究目的：开发一套基于模拟操作、侧重腹腔镜操作能力习得的微创手术（minimally invasive surgery）培训方案。 研究方法：本研究为前瞻性观察性研究，于2020年4月至2021年1月在巴西贝洛奥里藏特的一所大学医院开展。研究招募外科专科住院医师，依据动机激发、认知激活、示教演示、实操应用与整合内化等教学原则，开展结构化渐进式培训。分别于培训初始、中期与终期开展技能测试并录制视频，由一名外科教育专家匿名对录制内容进行评分。采用全球评估工具"GOALS"与专用缝合操作评分量表对受试者的个体操作表现进行评分。培训结束后，所有受试者均获得个性化反馈，并填写问卷以基于柯克帕特里克模型（Kirkpatrick model）评估培训的实施效果。 研究结果：共有43名住院医师完成全部培训项目。各阶段技能测试的操作表现呈现显著提升趋势。初始测试、中期测试与终期测试的平均得分分别为29%、43%与88%，各组平均得分间均存在显著统计学差异（H=97.59，自由度GL=2，p<0.0001）。受试者对培训方案的评价与学习体验均表现优异，但仅有10.7%的住院医师在培训结束后认为自己可独立完成低复杂度腹腔镜手术（laparoscopic surgery）操作。 研究结论：本研究开发的微创手术培训方案在腹腔镜外科教学领域具备可行性与应用前景。