Systematic training model for teaching, development and training of instructors in inguinal hernia treatment using the Lichtenstein technique. Hernia campaign 2014 & 2015.

ABSTRACT Objective: to evaluate the method of training and continuing education of 18 surgeons in 2014, and 28 surgeons in 2015, in the Holy Homes of Ribeirao Preto, Araraquara, Franca and San Carlos of São Paulo, in the performance of Lichtenstein inguinal herniorrhaphy, tutored by the Faculty of Medical Sciences of the São Paulo Holy Home and the organization HERNIA HELP - "Hernia Repair for the Underserved". Methods: the training was tutored and systematized through an active methodology of teaching and learning, aiming to offer competence, skills and attitudes, measured by a previously validated Qualification Form, qualifying leaders in trainees' improvement. Results: in 2014 the outcomes were: the difficulty of the case, direction, incision, dissection, mesh preparation, mesh cutting, mesh setting, closing, instruments, respect to tissues, flow, time and motion, and performance, all presented change in the general rating (p=0.000002); there was greater confidence in the execution of the procedure in 80% of trainees, considered "very valuable" in 93.3% of the interventions. In 2015, 28 surgeons were trained by ten surgeons previously qualified in 2014. The nerve identification rate, a relevant time the Lichtenstein technique, was 95.5% for the Iliohypogastric, 98.5% for the ilioinguinal and 89.4% for the genital branch of the genitofemoral nerve. Conclusion: the applied teaching method is possible, reproducible, reliable and valid. The joint efforts offer enormous opportunity of directed education, reaching underserved populations, revealing the great teacher-student social responsibility.摘要 研究目的：评估由圣保罗圣家医学院（Faculty of Medical Sciences of the São Paulo Holy Home）与非营利组织HERNIA HELP——全称"Hernia Repair for the Underserved"（即“为服务覆盖不足人群开展疝修补术”）牵头，于2014年、2015年分别在圣保罗州里贝朗普雷图、阿拉拉夸拉、弗朗卡、圣卡洛斯的圣家医疗点开展的李金斯坦腹股沟疝修补术（Lichtenstein inguinal herniorrhaphy）培训及继续教育模式，其中2014年参训外科医师共18名，2015年为28名。 研究方法：本次培训采用系统化带教模式，以主动式教学法为核心，旨在培育参训医师的专业能力、操作技能与职业素养，培训效果通过预先经过信效度验证的资质评定表进行考核，同时为受训医师队伍培育合格的带教骨干。 研究结果：2014年培训结果显示，病例难度把控、操作指引、切口制作、组织分离、补片准备、补片裁剪、补片放置、切口缝合、器械使用、组织保护、手术流程、时长与动作规范及整体操作表现等各项评分均较培训前发生显著变化（p=0.000002）；80%的参训医师对手术操作的自信心显著提升，93.3%的手术被评为"极具价值"。2015年，28名外科医师由2014年经培训合格的10名带教医师完成培训。李金斯坦术式中关键的神经识别步骤显示：髂腹下神经识别率为95.5%，髂腹股沟神经识别率为98.5%，生殖股神经生殖支识别率为89.4%。 研究结论：本次采用的教学模式具备可行性、可重复性、可靠性与有效性。多方协作可为服务覆盖不足人群的定向医学教育提供广阔空间，充分彰显了医教研团队的社会责任担当。