zdmeЗдоровье мегаполисаCity Healthcare2713-2617ГБУ «НИИОЗММ ДЗМ»10.47619/2713-2617.zm.2023.v.4i2;15-29zdme-109Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHESСпособ оценки эффективности симуляционного обучения лапароскопическому интракорпоральному швуMethod for Evaluating the Effectiveness of Simulation Training for Laparoscopic Intracorporeal Suturinghttps://orcid.org/0000-0002-0522-0681ШабунинА. В.ShabuninA. V.

Шабунин Алексей Васильевич – д-р мед. наук, главный врач, академик РАН

125284, г. Москва, 2-й Боткинский пр-д, 5

Alexey V. Shabunin – D. Sc. in Medicine, Chief Physician

5, pr-d 2nd Botkinsky, Moscow, 125284

https://orcid.org/0009-0001-4753-9084КлимаковА. В.KlimakovA. V.

Климаков Александр Владимирович – заместитель заведующего Учебно-аккредитационным центром – Медицинским симуляционным центром Боткинской больницы

125284, г. Москва, 2-й Боткинский пр-д, 5

Alexander V. Klimakov – Deputy Head of the Educational and Accreditation Center – Medical Simulation Center of the Botkin Hospital

5, pr-d 2nd Botkinsky, Moscow, 125284

klimakov.mscbotkin@gmail.comhttps://orcid.org/0000-0001-8687-526XЛогвиновЮ. И.LogvinovYu. I.

Логвинов Юрий Иванович – заведующий Учебно-аккредитационным центром – Медицинским симуляционным центром Боткинской больницы

125284, г. Москва, 2-й Боткинский пр-д, 5

Yuriy I. Logvinov – Head of the Educational and Accreditation Center – Medical Simulation Center of the Botkin Hospital

5, pr-d 2nd Botkinsky, Moscow, 125284

https://orcid.org/0000-0001-9727-2456МаерР. Ю.MaerR. Yu.

Маер Руслан Юрьевич – заведующий организационно-методическим отделом аппарата главного внештатного хирурга ДЗМ

125284, г. Москва, 2-й Боткинский пр-д, 5;

115184, г. Москва, Большая Татарская ул., 30

Ruslan Yu. Maer – Head of the Organizational and Methodological Department of the Office of the Chief Specialist in Surgery of Moscow Healthcare Department

5, pr-d 2nd Botkinsky, Moscow, 125284;

30, ul. Bol’shaya Tatarskaya, Moscow, 115184

Городская клиническая больница имени С. П. Боткина Департамента здравоохранения города МосквыBotkin City Clinical Hospital of Moscow Healthcare DepartmentГородская клиническая больница имени С. П. Боткина Департамента здравоохранения города Москвы; Научно-исследовательский институт организации здравоохранения и медицинского менеджмента Департамента здравоохранения города МосквыBotkin City Clinical Hospital of Moscow Healthcare Department; Research Institute for Healthcare Organization and Medical Management of Moscow Healthcare Department202327112023421529Copyright © Шабунин А.В., Климаков А.В., Логвинов Ю.И., Маер Р.Ю., 20232023Шабунин А.В., Климаков А.В., Логвинов Ю.И., Маер Р.Ю.Shabunin A.V., Klimakov A.V., Logvinov Y.I., Maer R.Y.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.city-healthcare.com/jour/article/view/109

Одним из важных умений хирурга является выполнение лапароскопического интракорпорального шва (ИКШ). Обучение этому целесообразно проводить в симуляционных условиях с последующим переносом умения в реальную практику. Конечной целью программ симуляционного обучения (СО) выполнению ИКШ является формирование у хирургов умения выполнять ИКШ на практике. Однако цели обучения достигаются не всегда – в операционной применяют ИКШ от 44,0 до 72,2 % прошедших обучение.Возникает необходимость оценки эффективности (ОЭ) СО и анализа влияющих на нее факторов. Целью ОЭ является повышение эффективности программ СО, внедрение в повседневную практику приобретенных знаний и умений врачами-хирургами.Согласно принятой концепции ОЭ обучения, предложенной Д. Киркпатриком, оценивать эффективность обучения нужно по результатам в практике и для генеральной совокупности обучаемых. Однако в ОЭ программ СО выполнению ИКШ не сложилось единого подхода. Применяемые в настоящее время способы оценивают результаты СО вне реальной практики либо в практике, но в ограниченных группах. Оценка эффективности СО в практике для генеральной совокупности обучаемых затруднена из-за высокой затратности и трудоемкости.Предложен способ ОЭ СО выполнению ИКШ (далее – Способ) с целью проводить оценку результатов в генеральной совокупности и дополнительных эффектов СО, а также осуществлять анализ персональных факторов, влияющих на результаты обучения. Способ основан на опросе участников программ СО и применен в Учебно-аккредитационном центре – Медицинском симуляционном центре Боткинской больницы для ОЭ программы СО выполнению ИКШ. Коэффициент переноса в практику умения выполнения ИКШ составил 88,9 %.Описываемый Способ позволяет оценивать эффективность СО выполнению ИКШ в генеральной совокупности обучаемых, анализировать факторы, влияющие на результаты обучения, учитывать результаты для совершенствования программ и методик СО в целом. Данный Способ может быть рекомендован для широкого применения в центрах СО.

Laparoscopic intracorporeal suturing (LIS) is one of the key skills in laparoscopic surgery. LIS training is conducted in simulation centers and is aimed at transferring the knowledge into practice. The simulation training (ST) is focused on the development of skills that allow surgeons to perform LIS operations. However, this goal is not completely achieved: only 44,0 to 72,2 % of surgeons implement LIS skills in their practice. here is a need to evaluate the effectiveness of such training programs and analyze factors that may influence the results. This evaluation is required to increase the effectiveness of LIS trainings and implement the acquired skills into practice by training surgeons.According to commonly accepted approach to evaluation of training programs suggested by D. Kirkpatrick., the method of effectiveness evaluation allows to estimate the practical results achieved by all trainees. Unfortunately, there are no commonly accepted methods aimed at evaluating the effectiveness of LIS training programs. The existing methods estimate the results of effectiveness evaluation in simulation (Dry lab) or practically, but in small groups. Effectiveness evaluation of LIS trainings implementation in surgical practice among all trainees is related to significant financial costs and complexity.A new effectiveness evaluation method of LIS simulation training programs (the Method) has been suggested. It is aimed at evaluating the total amount of results and other ST effects, as well as analyzing individual factors that can influence training results. The Method includes a survey among ST participants. It has been applied to effectiveness evaluation of LIS simulation training program at Educational and Accreditation Center of the Botkin City Clinical Hospital. The survey showed that 88.9% of surgeons attending the LIS training program implemented their knowledge into practice.The suggested Method allows to evaluate the effectiveness of LIS simulation training and its implementation into practice among all trainees, analyze factors that can influence the training results and use the obtained results for further improvement of the training program and its methods. The Method may be recommended for implementation at medical simulation training centers.

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The authors declare that there are no conflicts of interest present.