Modelo de treinamento para avaliar a progressão da competência na realização de nós e pontos em simulação de cirurgia laparoscópica

Abstract

To evaluate the progression of competency and the learning curve, degree of satisfaction with the training model and correlations between demographic data and competence of medical students undergoing practical, systematic, methodical training for performing knots and laparoscopic points in simulation environment. Methods: A prospective, longitudinal, interventional study was carried out between April 2016 and July 2017 with the participation of 52 medical students from the Christus University Center, Fortaleza, Brazil, from first to third year, subjected to practical theoretical training, systematized, with progression of skills for realization of laparoscopic points in simulation environment in four stages during 16 hours. A standardized task was established to perform laparoscopic points, with five throws, in suture mold, abdominal cavity simulator, in 18 minutes. The students were evaluated at all stages of the training as to the quantity and quality of the points and satisfaction with the training model. ANOVA and Student's T tests were performed to compare data from the independent samples and chi-square test to the categorical ones. For variables with serial measurements, the general linear model, was used. Univariate binomial models were used to verify the percentage of responses, with a cutoff point, in variables of training model. Values of "p" less than 0.05, were consider significant. Results: Yielded a median value of across the first and last stages of the training. The medians of the number of throws (0,0 and 15,0), laparoscopic points (0,0 and 3,0), adequacy of thread lengths (0,0 and 11,0), number of adjustments of the initial throws (0.0 and 3.0) and the adjustments of sequential throws (0.0 and 24.0) between the first and last steps. Statistical significance was found in all parameters evaluated. The learning curve showed that 99.1% of students reached proficiency. In eight to ten affirmations, about the degree of satisfactory in training model, 97% or more of the students, evaluated as good or great, with statistical relevance. None demographic data, correlated significantly with evolution of competence. Conclusion: Students progressed in competence and evolution along the learning curve at the end of the training. The degree of satisfaction of students, regarding the stages of the training model, was very significant and there was no correlation between demographic data and competence reached by students.

Key Words: Laparoscopic surgery. Simulation-based learning. Medical education. Surgical skills.