制定客观的技术技能评估腹腔镜下缝合和体内打结

制定客观的技术技能评估腹腔镜下缝合和体内打结
Developing an Objective Structured Assessment of Technical Skills for Laparoscopic Suturing and Intracorporeal Knot Tying

Abstract
摘要
OBJECTIVE:
目的：
To develop a teaching and assessment tool for laparoscopic suturing and intracorporeal knot tying.
制定腹腔镜缝合和体内打结教学和评估工具。

DESIGN AND SETTING:
设计与设置：
We designed an Objective Structured Assessment of Technical Skills (OSATS) tool that includes a procedure-specific checklist (PSC) and global rating scale (GRS) to assess laparoscopic suturing and intracorporeal knot-tying performance. Obstetrics and Gynecology residents at our institution were videotaped while performing a laparoscopic suturing and intracorporeal knot-tying task at a surgical simulation workshop. A total of 2 expert reviewers assessed resident performance using the OSATS tool during live performance and 1 month later using the videotaped recordings. OSATS scores were analyzed using the Wilcoxon rank-sum test. Data are presented as median scores (interquartile range [IQR]). Intrarater and interrater reliabilities were assessed using a Spearman correlation and are presented as an r correlation coefficient and p value. An r ≥ 0.8 was considered as a high correlation. After testing, we received feedback from residents and faculty to improve the OSATS tool as part of an iterative design process.
我们设计了一个客观的结构化评估的技术技能（OSATS）的工具，包括一个程序特定的清单（PSC）和全球评定量表（GRS）探讨腹腔镜缝合和体内打结性能。在我院妇产科住院医师录像同时进行腹腔镜下缝合和体内打结的任务在手术模拟间。共有2位专家评估住院医师使用osats工具在现场演示的性能，1个月后使用录像录音。osats评分采用Wilcoxon等级和检验分析。数据均以平均得分（四分位距[IQR]）。组内和间信度分别采用Spearman相关评估和给出的相关系数r和P值。R≥0.8为高度相关。经过测试，我们收到了来自当地住院医师和全体教职员的反馈意见，以提高osats工具作为一个迭代设计过程的一部分。

PARTICIPANTS:
参与者:
In all, 14 of 21 residents (66.7%) completed the study, with 9 junior residents and 5 senior residents.
在所有的21名住院医师中，有14人（66.7%）完成了这项研究，有9名初级住院医师和5名高级住院医师。

RESULTS:
结果:
Junior residents had a lower score on the PSC than senior residents did; however, this was not statistically significant (median = 6.0 [IQR: 4.0-10.0] and median = 13.0 [IQR: 10.0-13.0]; p = 0.09). There was excellent intrarater reliability with our OSATS tool (for PSC component, r = 0.88 for Rater 1 and 0.93 for Rater 2, both p < 0.0001; for GRS component, r = 0.85 for Rater 1 and 0.88 for Rater 2, both p ≤ 0.0002). The PSC also has high interrater reliability during live evaluation (r = 0.92; p < 0.0001), and during the videotape scoring with r = 0.77 (p = 0.001).
初级住院医师在PSC有一个较低的得分与高级住院医师比；然而，这并没有显著的统计学意义（median = 6.0 [IQR: 4.0-10.0] and median = 13.0 [IQR: 10.0-13.0]; p = 0.09）。我们osats工具有良好的信度（for PSC component, r = 0.88 for Rater 1 and 0.93 for Rater 2, both p < 0.0001; for GRS component, r = 0.85 for Rater 1 and 0.88 for Rater 2, both p ≤ 0.0002）。PSC也具有很高的信度在现场评价（R = 0.92；P＜0.0001），并在录像带与R = 0.77评分（P = 0.001）。

CONCLUSIONS:
结论：
Our OSATS tool may be a useful assessment and teaching tool for laparoscopic suturing and intracorporeal knot-tying skills. Overall, good intrarater reliability was demonstrated, suggesting that this tool may be useful for longitudinal assessment of surgical skills.
我们的osats工具可以用于腹腔镜缝合和体内打结技能有用的评价和教学工具。总的来说，好的信度的证明，表明该工具可以对手术技巧的纵向评估是有用的。

原文：
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