부산대학교 도서관

Background: While surgical simulation is regularly used in surgical training in high-income country settings, it is uncommon in low- and middle-income countries, particularly for surgical training that primarily occurs in rural areas. We designed and evaluated a novel surgical simulator for improving trachomatous trichiasis (TT) surgery training, given that trichiasis is mostly found among the poorest individuals in rural areas. Methodology/Principal findings: TT surgery programs were invited to incorporate surgical simulation with a new, high fidelity, low-cost simulator into their training. Trainees completed standard TT-surgery training following World Health Organization guidelines. A subset of trainees received three hours of supplemental training with the simulator between classroom and live-surgery training. We recorded the time required to complete each surgery and the number of times the trainer intervened to correct surgical steps. Participants completed questionnaires regarding their perceptions. We also assessed trainer and trainee perceptions of surgical simulation training as part of trichiasis surgery training. 22 surgeons completed standard training and 26 completed standard training plus simulation. We observed 1,394 live-training surgeries. Average time to first live-training surgery completion was nearly 20% shorter the simulation versus the standard group (vs 34.4 minutes; p = 0.02). Trainers intervened significantly fewer times during initial live-training surgeries in the simulation group (2.7 vs. 4.8; p = 0.005). All trainers indicated the simulator significantly improved training by allowing trainees to practice safely and to identify problem areas before performing live-training surgeries. Trainees reported that simulation practice improved their confidence and skills prior to performing live-training surgeries. Conclusions: A single high-fidelity surgical simulation session can significantly improve critical aspects of initial TT surgeries. Author summary: Approximately 1.7 million people globally have an eyelid condition called trachomatous trichiasis (TT) resulting from repeated ocular bacterial infections that caused the eyelid to scar and turn in so that the eyelashes rub against the eye. TT can be corrected through surgery. However, TT is mostly found in areas with limited health care resources. Thus, nurses are trained how to perform the surgery. Historically, training has been limited to one week of classroom training followed by three weeks of live-surgery practical training. This study describes a surgical simulator the authors developed to improve the training process. After a three-hour training with the HEAD START simulator, trainees required less assistance from the trainer during live-patient surgical practice and performed surgery faster than those not trained on HEAD START. [ABSTRACT FROM AUTHOR]