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中华疝和腹壁外科杂志(电子版)

中华疝和腹壁外科杂志(电子版) ›› 2022, Vol. 16 ›› Issue (01) : 53 -57. doi: 10.3877/cma.j.issn.1674-392X.2022.01.012

临床论著

基于Kirkpatrick's四级培训评估模型腔镜腹股沟疝培训课程的效果分析
汤福鑫1, 马宁1, 江志鹏1, 李英儒1, 甘文昌1, 侯泽辉1, 周太成1,†(), 陈双1   
  1. 1. 510655　广州，中山大学附属第六医院胃肠、腹壁及疝外科，广东省胃肠病学研究所　广东省结直肠盆底疾病研究重点实验室　国家临床重点专科
  • 收稿日期:2019-12-10 出版日期:2022-02-18
  • 通信作者: 周太成
  • 基金资助:
    广东省科技计划项目(2021A1515410004); 广州市科技计划项目(2022010630010045)

An analysis of the effectiveness of the laparoscopic inguinal hernia training course based on Kirkpatrick's four-level training evaluation model

Fuxin Tang1, Ning Ma1, Zhipeng Jiang1, Yingru Li1, Wenchang Gan1, Zehui Hou1, Taicheng Zhou1,†(), Shuang Chen1   

  1. 1. Department of Gastrointestinal Surgery and Hernia Center, The Sixth Affiliated Hospital of Sun Yat-Sen University, Guangdong Institute of Gastroenterology、Guangdong Provincial Key Laboratory of Colorectal and Pelvic Floor Diseases、Supported by National Key Clinical Discipline, Guangzhou 510655, China
  • Received:2019-12-10 Published:2022-02-18
  • Corresponding author: Taicheng Zhou
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引用本文：

汤福鑫, 马宁, 江志鹏, 李英儒, 甘文昌, 侯泽辉, 周太成, 陈双. 基于Kirkpatrick's四级培训评估模型腔镜腹股沟疝培训课程的效果分析[J]. 中华疝和腹壁外科杂志(电子版), 2022, 16(01): 53-57.

Fuxin Tang, Ning Ma, Zhipeng Jiang, Yingru Li, Wenchang Gan, Zehui Hou, Taicheng Zhou, Shuang Chen. An analysis of the effectiveness of the laparoscopic inguinal hernia training course based on Kirkpatrick's four-level training evaluation model[J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2022, 16(01): 53-57.

目的

探讨腔镜腹股沟疝技术培训班的临床效果。

方法

对参加中山大学附属第六医院胃肠、疝和腹壁外科2018年8月20至24日举办的腹股沟疝腔镜技术培训班的64名学员进行回顾性横断面研究。开展腔镜疝修补时间0~6年，平均手术时间（2.1±1.6）年。对学员培训前、培训结束时及培训3~6个月后前后进行问卷调查学员对培训课程的反馈，培训前及培训后3~6个月的手术表现，并基于Kirkpatrick's四级培训评估模型对结果进行分析。腹股沟疝腔镜技术培训班包括腔镜基础技能培训、腹股沟疝手术相关理论授课及手术演示。

结果

有64.5%学员对培训课程表示满意。培训后3个月发出调查问卷64份，回收39份，回答率约39/64（60.9%）。回复的学员中，培训前23名有腹腔镜经腹腹膜前疝修补术（TAPP）经验，10名有腹腔镜完全腹膜外疝修补术（TEP）经验，6名是初学者。其中，有TAPP经验的学员中，每一步骤平均自信心得分从培训前的（3.23±0.94）分提高到（3.73±0.68）分，差异有统计学意义（P<0.05）；有TEP经验的10名学员中，每一步骤平均自信心得分从（2.99±0.84）分提高到（3.76±0.58）分，差异有统计学意义（P<0.05）。以初发单侧腹股沟疝为例，TAPP手术时间从培训前的97.6 min减少到培训后76.3 min，TEP手术时间从培训前102.0 min减少到培训后76.5 min（P<0.05）；TAPP手术出血量从培训前13.9 ml减少到培训后7.7 ml，TEP手术出血量从培训前17.0 ml减少到培训后8.4 ml，学员手术表现得到明显提升（P<0.05）。在6名初学者中，有4名已开展TAPP，2名仍未开展TAPP或TEP。

结论

开展腹腔镜腹股沟疝手术前参加规范化的腔镜腹股沟疝技术培训课程非常重要，通过参加腹腔镜腹股沟疝技术培训班可以明显提升医师的手术水平。

关键词: 疝，腹股沟, 腹腔镜, 技术培训, 效果分析, Kirkpatrick's四级评估模型
Objective

This article investigated the clinical effect of the laparoscopic inguinal hernia technical training course.

Methods

A retrospective cross-sectional studyin was conducted on 64 trainees who participated in the inguinal hernia endoscopy technical training, which was held by the Department of Gastrointestinal Surgery and Hernia and Abdominal Wall Surgery in the Sixth Affiliated Hospital of Sun Yat-Sen University from August 20 to 24, 2018. The duration of laparoscopic hernia repair was 0~6 (average operative time 2.1±1.6) years. We distributed questionnaires to trainees before, at the end of and 3~6 months after the training. The main contents of the questionnaire include their feedbacks on the training course, and also their surgery performance before and 3 to 6 months after the training. We analyzed the survey results based on Kirkpatrick's four-level training evaluation model. The inguinal hernia endoscopy technical training includes basic skills training on endoscopy, lectures on inguinal hernia surgery theories, and surgery demonstrations.

Results

64.5% of the trainees were satisfied with the training course. 3 months after the training, we distributed 64 questionnaires and 39 were recovered. The response rate was 39/64 (60.9%). According to these respondents, twenty-three trainees have already had TAPP experience; ten trainees have had TEP experience; six trainees were beginners. Trainees with TAPP experience improved the average confidence score in each step of TAPP from (3.23±0.94) points before training to (3.73±0.68) points after training (P<0.05). Trainees with TEP experience increased the average confidence score in each step of TEP from (2.99±0.84) to (3.76±0.58) points (P<0.05). Take the primary unilateral inguinal hernia as an example, the operative time of TAPP decreased from 97.6 minutes before training to 76.3 minutes after training, and the operative time of TEP decreased from 102.0 to 76.5 minutes (P<0.05). The operative blood loss of TAPP decreased from 13.9 ml before training to 7.7 ml after training. The operative blood loss of TEP decreased from 17.0 ml to 8.4 ml (P<0.05). This indicated that the surgical performance of trainees improved significantly. Four of the six beginners have started TAPP, but two beginners haven't started TAPP or TEP yet.

Conclusion

It is extremely important to take the standardized training course for laparoscopic inguinal hernia repair before performing the surgery. The surgery performance can be significantly improve by taking the laparoscopic inguinal hernia technical training course.

Key words: Inguinal hernia, Laparoscope, Technical training, Effect analysis, Kirkpatrick's four-level evaluation model
表1 64名学员一般资料
项目 例(%)
性别  
  男性 63(98.4)
  女性 1(1.6)
学历结构  
  学士 43(67.2)
  硕士研究生 18(28.1)
  博士研究生 3(4.7)
职称  
  初级 7(10.9)
  中级 27(42.2)
  高级 30(46.9)
工作医院级别  
  三甲 31(48.4)
  二甲 26(40.6)
  二乙 1(1.6)
  一甲 6(9.4)
腹股沟疝修补手术经验  
  有 64(100)
  无 0(0)
腹腔镜手术经验  
  有 64(100)
  无 0(0)
腔镜疝修补开展情况  
  TAPP 38(59.4)
  TEP 25(39.1)
  TAPP和TEP 21(32.8)
腔镜疝修补时间(年)  
  无 10(15.6)
  1~5 52(81.3)
  6~10 2(3.1)
表2 64名学员课程具体评价情况[例（%）]
项目 不同意 中立 同意
课程培训目标明确   2(3.1) 62(96.9)
老师准备充分   2(3.1) 62(96.9)
老师有较高的学术水平   2(3.1) 62(96.9)
老师交流积极   1(1.6) 63(98.4)
教学方法适宜   4(6.3) 60(93.7)
课程丰富有趣   3(4.7) 61(95.3)
时间安排合理   3(4.7) 61(95.3)
课程理论与实践充分结合   1(1.6) 63(98.4)
培训设备充分 2(3.1) 4(6.3) 58(90.6)
我认为花费的时间是值得的   2(3.1) 62(96.9)
学员有充分的机会进行讨论和交流 2(3.1) 5(7.8) 59(92.2)
这个课程将会帮助提高我的专业能力   3(4.7) 61(95.3)
这个课程使我意识到继续学习的重要性     64(100.0)
国内应该有更多这样类似的培训课程     64(100.0)
我能够将大部分这次所学知识应用到工作去   1(1.6) 63(98.4)
表3 33名学员TAPP和TEP手术培训前、后自信心评分（分）
步骤 培训前 培训后 P值
TAPP 3.23±0.94 3.73±0.68 <0.05
放置套管 3.83±1.34 4.30±0.82  
切开腹膜 3.39±1.12 3.96±0.71  
分离间隙 3.26±0.69 3.65±0.49  
分离疝囊 3.09±0.51 3.52±0.51  
去腹膜化 3.00±0.74 3.48±0.59  
放置补片 3.26±0.86 3.74±0.62  
关闭腹膜 2.78±0.80 3.48±0.59  
TEP 2.99±0.84 3.76±0.58 <0.05
放置套管 3.00±0.82 3.80±0.63  
建立空间 2.80±0.63 3.70±0.48  
分离间隙 2.70±0.67 3.50±0.53  
分离疝囊 2.80±0.63 3.60±0.52  
去腹膜化 2.70±0.82 3.50±0.53  
放置补片 3.20±0.63 3.90±0.32  
关闭气腹 3.50±1.27 4.30±0.67  
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