培训的培训者在内镜黏膜下剥离术培训中的应用

doi:10.3877/cma.j.issn.1674-6899.2018.03.016

中华腔镜外科杂志(电子版) ›› 2018, Vol. 11 ›› Issue (03): 172 -175. doi: 10.3877/cma.j.issn.1674-6899.2018.03.016

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培训的培训者在内镜黏膜下剥离术培训中的应用

李丛勇 ¹, 田乐 ², 栾哲 ³, 郭亮亮 ², 刘江涛 ², 孙刚 ⁴ ^, ^†(

), 张晓梅 ², 冯青 ², 叶玲玲 ², 闫斌 ³, 王淑芳 ⁴

^1. 100853 北京，解放军总医院消化内科；100048 北京，海军总医院干部病房消化内科
^2. 572013 三亚，解放军总医院海南分院消化内科
^3. 100853 北京，解放军总医院消化内科
^4. 100853 北京，解放军总医院消化内科；572013 三亚，解放军总医院海南分院消化内科

收稿日期:2018-03-22 出版日期:2018-06-30
通信作者: 孙刚
基金资助:
海南省重点研发计划(ZDYF2017094，ZDYF2017105，ZDYF2018162); 军队医学科学十二五规划(BWS13C027); 2016军队转化医学项目(2016TM－035)

The effect of train the trainer profile in ESD training

Congyong Li ¹, Le Tian ², Zhe Luan ³, Liangliang Guo ², Jiangtao Liu ², Gang Sun ⁴ ^, ^†( ), Xiaomei Zhang ², Qing Feng ², Lingling Ye ², Bin Yan ³, Shufang Wang ⁴

^1. Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China; Department of Gastroenterology, Cardre Ward, Navy General Hospital of PLA, Beijing 100048, China
^2. Department of Gastroenterology and Hepatology, Hainan Branch of Chinese PLA General Hospital, Sanya 572000, China
^3. Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China
^4. Department of Gastroenterology and Hepatology, Chinese PLA General Hospital, Beijing 100853, China; Department of Gastroenterology and Hepatology, Hainan Branch of Chinese PLA General Hospital, Sanya 572000, China

Received:2018-03-22 Published:2018-06-30
Corresponding author: Gang Sun
About author:
Corresponding author: Sun Gang, Email: sunok301@126.com

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目的

探讨培训的培训者(train the trainer, TTT)培训模式在内镜黏膜下剥离术(endoscopic submucosal dissection，ESD)模拟培训中的效果。

方法

以6位受训者(内镜操作≥ 500例，无ESD操作经验)为研究对象，由培训者(ESD专家，人体ESD操作≥ 100例次)对受训者首先进行理论培训，然后应用离体猪胃模型进行第1轮的手把手初级培训；在后续轮次培训中，每一位受训者担任培训者，指导其他受训者完成ESD操作(角色转换)。通过比较受训者培训前后的总操作时间、环切时间、黏膜下剥离时间并记录病变是否完整切除、穿孔并发症，评价TTT培训模式提高受训者操作水平的作用。

结果

6位受训者接受5轮次培训，完成30处病变模拟ESD操作，操作时间明显缩短，总操作时间、环切时间、黏膜下剥离时间分别从(37.33 ± 5.85)min、(12.83 ± 2.93)min、(24.50 ± 3.39)min缩短到(24.50 ± 4.59)min、(7.33 ± 1.63)min、(13.00 ± 3.58)min；其中未完整切除标本4例、穿孔1例，均发生在培训的前3轮次。通过观察受训者的学习曲线发现，受训者ESD操作时间逐渐缩短，第4轮次与培训以后的操作时间比较，无明显差异(P> 0.05)。

结论

TTT培训模式，通过角色转换促进受训者的主动学习，经过4轮次培训达到离体猪胃模拟ESD操作的技术稳定和操作时间稳定。该培训模式值得进一步扩大研究和推广。

关键词: 培训的培训者, 内镜下黏膜剥离术, 离体模型

Objective

To evaluate the effect of train the trainer profile in ESD simulated training.

Methods

Six endoscopists with no ESD experience were included. They firstly received didactic material and theoretical aspects of ESD. Then, they underwent the training program using an ex-vivo animal (swine) model (esophagus-stomach) stimulating the human body ESD procedure. During the following training sequences, the previous trainee acted as an assistant and stimulated the "trainer" to train the next trainee (role transition). We accessed the efficacy of TTT on raising operation level of trainee by comparing the time for total operation , time for mark lesions, time for circumferential incision and recording the en-bloc resection rate and the ESD-related perforation.

Results

Six trainees received 5 rounds TTT training, performed a total of 30 simulation ESD operation in ex-vivo model. The operation time was shortened obviously. The total operating time, circumferential incision time, time for submucosal dissection respectively decreased from (37.33 ± 5.85)min, (12.83 ± 2.93)min, (24.50 ± 3.39)min to (24.50 ± 4.59)min, (7.33 ± 1.63)min, (13.00 ± 3.58)min. Uncomplete resection was achieved in 4 cases and with 1 case of perforation recorded, all occured in the first 3 rounds of training. As showed in the learning curve of the trainee, the duration of ESD operation was shortened and there was no significant difference in operation time after the 4 rounds of training (P>0.05).

Conclusions

TTT training profile is feasible and effective to improve the active learning by role conversion. The operation time were stable after 4 rounds training. However, further study is needed for the in-vivo animal/swine model ESD training.

Key words: Train The Trainer, Endoscopic submucosal dissection, Ex-vivo swain model

图1 离体猪胃固定箱

表1 6位培训者的模拟训练前后各操作时间的对比(min， ±s)

时间	第1轮时间	第3轮时间	第4轮时间	第5轮时间	P₁值	P₂值	P₃值
总操作时间	37.33 ± 5.85	34.33 ± 3.39	24.50 ± 6.72	24.50 ± 4.59	0.0047	0.0514	1.0000
环切时间	12.83 ± 2.93	9.33 ± 2.34	6.33 ± 2.42	7.33 ± 1.63	0.0016	0.1366	0.2292
黏膜下剥离时间	24.50 ± 3.39	20.50 ± 1.22	14.17 ± 4.40	13.00 ± 3.58	0.0012	0.0157	0.0842

表1 6位培训者的模拟训练前后各操作时间的对比(min， ±s)

时间	第1轮时间	第3轮时间	第4轮时间	第5轮时间	P₁值	P₂值	P₃值
总操作时间	37.33 ± 5.85	34.33 ± 3.39	24.50 ± 6.72	24.50 ± 4.59	0.0047	0.0514	1.0000
环切时间	12.83 ± 2.93	9.33 ± 2.34	6.33 ± 2.42	7.33 ± 1.63	0.0016	0.1366	0.2292
黏膜下剥离时间	24.50 ± 3.39	20.50 ± 1.22	14.17 ± 4.40	13.00 ± 3.58	0.0012	0.0157	0.0842

图2 受训者内镜黏膜下剥离术的相关操作时间

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