Evaluación Objetiva de las Habilidades Técnicas en Cirugía
DOI:
https://doi.org/10.11565/arsmed.v43i3.1112Palabras clave:
Habilidades, Habilidades TécnicasResumen
Introducción: La enseñanza tradicional de la cirugía se ha basado en la observación y retroalimentación directa por parte de un experto. Esto corresponde a una evaluación subjetiva y requiere de un tiempo mínimo de exposición no siempre fácil de obtener. Los resultados adversos y complicaciones se traducen en gastos innecesarios para los servicios de salud. Surge la necesidad de nuevos métodos de evaluación objetiva de las habilidades quirúrgicas. Se presenta una revisión de la literatura respecto a los métodos objetivos de evaluación de las habilidades técnicas en cirugía que actualmente existen y dar a conocer una nueva metodología de evaluación actualmente en desarrollo.
Métodos: Se realizó una revisión de la literatura, utilizando PubMed, Google Scholar y Scielo. Se incluyeron estudios en inglés y español que utilizaron métodos objetivos estandarizados de evaluación de técnicas quirúrgicas, ya sea con técnica abierta o laparoscópica, además de revisiones de la literatura.
Resultados: Se incluyeron las escalas OSATS, GOALS, GAGES, métodos basados en simulación y otros aún en desarrollo. Las escalas de evaluación han sido validadas en un gran número de procedimientos. La simulación en el área quirúrgica ha permitido generar una evaluación y retroalimentación previa al escenario operatorio real, reduciendo la tasa de errores e incrementando la eficiencia en éste. La Caja Negra es un método novedoso que incluye una gran cantidad de variables, permitiendo detectar pequeñas variaciones o errores en la ejecución de la técnica, lo que permite una evaluación más certera.
Conclusiones: Múltiples métodos de evaluación objetiva de las habilidades técnicas han sido desarrollados y validados. Se espera que exista una incorporación sistemática de estas herramientas en los programas de formación de cirujanos de nuestro país.
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Aggarwal R, Grantcharov TP & Darzi A (2007). Framework for Systematic Training and Assessment of Technical Skills. J Am Coll Surg 204, 697–705. DOI: https://doi.org/10.1016/j.jamcollsurg.2007.01.016
Aggarwal R, Ward J, Balasundaram I, Sains P, Athanasiou T & Darzi A (2007). Proving the effectiveness of virtual reality simulation for training in laparoscopic surgery. Ann Surg 246, 771–9. DOI: https://doi.org/10.1097/SLA.0b013e3180f61b09
Ahlberg G, Hultcrantz R, Jaramillo E, Lindblom A & Arvidsson D (2005). Virtual reality colonoscopy simulation: a compulsory practice for the future colonoscopist? Endoscopy 37, 1198–1204. DOI: https://doi.org/10.1055/s-2005-921049
Beard J, Marriott J, Purdie H & Crossley J (2011). Assessing the surgical skills of trainees in the operating theatre: a prospective observational study of the methodology. Health Technol Assess 15. DOI: https://doi.org/10.3310/hta15010
Bezemer J, Cope A, Korkiakangas T, Kress G, Murtagh G, Weldon S-M & Kneebone R (2017). Microanalysis of video from the operating room: an underused approach to patient safety research. BMJ Qual Saf. 26, 583–7. DOI: https://doi.org/10.1136/bmjqs-2016-005816
Buckley CE, Kavanagh DO, Traynor O & Neary PC (2014). Is the skillset obtained in surgical simulation transferable to the operating theatre? Am J Surg. 207, 146–57. DOI: https://doi.org/10.1016/j.amjsurg.2013.06.017
Cohen J, Cohen SA, Vora KC, Xue X, Burdick JS, Bank S, Bini EJ, Bodenheimer H, Cerulli M, Gerdes H, Greenwald D, Gress F, Grosman I, Hawes R, Mullin G, Schnoll-Sussman F, Starpoli A, Stevens P, Tenner S & Villanueva G (2006). Multicenter, randomized, controlled trial of virtual-reality simulator training in acquisition of competency in colonoscopy. Gastrointest Endosc. 64, 361–368. DOI: https://doi.org/10.1016/j.gie.2005.11.062
Ende A, Zopf Y, Konturek P, Naegel A, Hahn EG, Matthes K & Maiss J (2012). Strategies for training in diagnostic upper endoscopy: a prospective, randomized trial. Gastrointest Endosc. 75, 254 – 260. DOI: https://doi.org/10.1016/j.gie.2011.07.063
Eubanks TR, Clements RH, Pohl D, Williams N, Schaad DC, Horgan S & Pellegrini C (1999). An objective scoring system for laparoscopic cholecystectomy. J Am Coll Surg. 189, 566–574. DOI: https://doi.org/10.1016/S1072-7515(99)00218-5
Gallagher AG, Ritter EM & Satava RM (2003). Fundamental principles of validation, and reliability: rigorous science for the assessment of surgical education and training. Surg Endosc; 17, 1525–1529 DOI: https://doi.org/10.1007/s00464-003-0035-4
Gambadauro P & Magos A (2012). Surgical videos for accident analysis, performance improvement, and complication prevention: Time for a surgical black box? Surg Innov. 19, 76–80. DOI: https://doi.org/10.1177/1553350611415424
Garbens A, Goldenberg M, Wallis CJD, Tricco A & Grantcharov TP (2018). The cost of intraoperative adverse events in abdominal and pelvic surgery: A systematic review. Am J Surg. 215, 163-170. DOI: https://doi.org/10.1016/j.amjsurg.2017.06.025
Goldenberg MG & Grantcharov TP (2016). Video-analysis for the assessment of practical skill. Tijdschr voor Urol. 6, 128–36. DOI: https://doi.org/10.1007/s13629-016-0156-x
Goldenberg MG, Jung J & Grantcharov TP (2017). Using Data to Enhance Performance and Improve Quality and Safety in Surgery. JAMA Surg. 152, 972. DOI: https://doi.org/10.1001/jamasurg.2017.2888
Grantcharov TP, Kristiansen VB, Bendix J, Bardram L, Rosenberg J & Funch-Jensen P (2004). Randomized clinical trial of virtual reality simulation for laparoscopic skills training. Br J Surg. 91, 146–50. DOI: https://doi.org/10.1002/bjs.4407
Grantcharov TP & Reznick RK (2008). Teaching procedural skills. Bmj. 336, 1129–31. DOI: https://doi.org/10.1136/bmj.39517.686956.47
Grantcharov TP, Schulze S & Kristiansen VB (2007). The impact of objective assessment and constructive feedback on improvement of laparoscopic performance in the operating room. Surg Endosc Other Interv Tech. 21, 2240–3. DOI: https://doi.org/10.1007/s00464-007-9356-z
Gumbs AA, Hogle NJ & Fowler DL (2007). Evaluation of Resident Laparoscopic Performance Using Global Operative Assessment of Laparoscopic Skills. J Am Coll Surg. 204, 308–13. DOI: https://doi.org/10.1016/j.jamcollsurg.2006.11.010
Hatala R, Cook DA, Brydges R & Hawkins R (2015). Constructing a validity argument for the Objective Structured Assessment of Technical Skills (OSATS): a systematic review of validity evidence. Adv Heal Sci Educ. 20, 1149–75. DOI: https://doi.org/10.1007/s10459-015-9593-1
Healey AN, Sevdalis N & Vincent CA (2006). Measuring intra-operative interference from distraction and interruption observed in the operating theatre. Ergonomics. 49, 589–604. DOI: https://doi.org/10.1080/00140130600568899
Hogle NJ, Liu Y, Ogden RT & Fowler DL (2014). Evaluation of surgical fellows’ laparoscopic performance using Global Operative Assessment of Laparoscopic Skills (GOALS). Surg Endosc Other Interv Tech. 28, 1284–90. DOI: https://doi.org/10.1007/s00464-013-3324-6
Jarufe N & Barra M (2017). Comenzando un nuevo periodo con eÌnfasis en la educacioÌn quiruÌrgica y las regiones. Rev Chil Cir. 69, 103-104. DOI: https://doi.org/10.1016/j.rchic.2017.01.010
Korndorffer JR, Dunne JB, Sierra R, Stefanidis D, Touchard CL & Scott DJ (2005). Simulator training for laparoscopic suturing using performance goals translates to the operating room. J Am Coll Surg. 201, 23–9. DOI: https://doi.org/10.1016/j.jamcollsurg.2005.02.021
Kurashima Y, Feldman LS, Al-Sabah S, Kaneva PA, Fried GM & Vassiliou MC (2011). A tool for training and evaluation of laparoscopic inguinal hernia repair: The global operative assessment of laparoscopic skills-groin hernia (GOALS-GH). Am J Surg. 201, 54–61 DOI: https://doi.org/10.1016/j.amjsurg.2010.09.006
Martin JA, Regehr G, Reznick R, Macrae H, Murnaghan J, Hutchison C & Brown M (1997). Objective structured assessment of technical skill (OSATS) for surgical residents. Br J Surg. 84, 273–8. DOI: https://doi.org/10.1046/j.1365-2168.1997.02502.x
Mikrogianakis A, Kam A, Silver S, Bakanisi B, Henao O, Okrainec A & Azzie G (2011). Telesimulation: An Innovative and Effective Tool for Teaching Novel Intraosseous Insertion Techniques in Developing Countries. Acad Emerg Med. 18,420–7. DOI: https://doi.org/10.1111/j.1553-2712.2011.01038.x
Moya R P, Ruz A M, Parraguez L E, Carreño E V, Rodríguez C AM & Froes M P (2017). Efectividad de la simulación en la educación médica desde la perspectiva de seguridad de pacientes. Rev Med Chil. 145, 514–26 DOI: https://doi.org/10.4067/S0034-98872017000400012
Niitsu H, Hirabayashi N, Yoshimitsu M, Mimura T, Taomoto J, Sugiyama Y, Murakami S, Saeki S, Mukaida H & Takiyama W (2013). Using the Objective Structured Assessment of Technical Skills (OSATS) global rating scale to evaluate the skills of surgical trainees in the operating room. Surg Today 43, 271–5 DOI: https://doi.org/10.1007/s00595-012-0313-7
Okrainec A, Henao O & Azzie G (2010). Telesimulation: an effective method for teaching the fundamentals of laparoscopic surgery in resource-restricted countries. Surg Endosc. 24, 417–22 DOI: https://doi.org/10.1007/s00464-009-0572-6
Park J, Mac Rae H, Musselman LJ, Rossos P, Hamstra SJ, Wolman S & Reznick RK (2007). Randomized controlled trial of virtual reality simulator training: transfer to live patients. Am J Surg 194, 205– 211 DOI: https://doi.org/10.1016/j.amjsurg.2006.11.032
Sachs TE & Pawlik TM (2015). See one, do one, and teach none: Resident experience as a teaching assistant. J Surg Res 195, 44–51 DOI: https://doi.org/10.1016/j.jss.2014.08.001
Sarker SK, Chang A, Vincent C & Darzi SA (2006). Development of assessing generic and specific technical skills in laparoscopic surgery. Am J Surg 191, 238–244. DOI: https://doi.org/10.1016/j.amjsurg.2005.07.031
Shippey SH, Chen TL, Chou B, Knoepp LR, Bowen CW & Handa VL (2011). Teaching subcuticular suturing to medical students: video versus expert instructor feedback. J Surg Educ 68, 397-402. DOI: https://doi.org/10.1016/j.jsurg.2011.04.006
Stefanidis D & Acker C (2008). Proficiency-Based Laparoscopic Simulator Training Leads to Improved Operating Room Skill That Is Resistant to Decay. Surg Innov 15, 69–73. DOI: https://doi.org/10.1177/1553350608316683
Stefanidis D, Korndorffer JR, Markley S, Sierra R, Heniford BT & Scott DJ (2007). Closing the Gap in Operative Performance Between Novices and Experts: Does Harder Mean Better for Laparoscopic Simulator Training? J Am Coll Surg. 205, 307–13 DOI: https://doi.org/10.1016/j.jamcollsurg.2007.02.080
Stefanidis D, Yonce TC, Korndorffer JR Jr, Phillips R & Coker A (2013). Does the incorporation of motion metrics into the existing FLS metrics lead to improved skill acquisition on simulators? A single blinded, randomized con- trolled trial. Ann Surg. 258, 46-52 DOI: https://doi.org/10.1097/SLA.0b013e318285f531
Vaillancourt M, Ghaderi I, Kaneva P, Vassiliou M, Kolozsvari N, George I, Sutton FE, Seagull FJ, Park AE, Fried GM & Feldman LS (2011). GOALS-incisional hernia: a valid assessment of simulated laparoscopic incisional hernia repair. Surg Innov. 18, 48–54 DOI: https://doi.org/10.1177/1553350610389826
Van Hove PD, Tuijthof GJ, Verdaasdonk EG, Stassen LP & Dankelman J (2010). Objective assessment of technical surgical skills. Br J Surg 97, 972–87 DOI: https://doi.org/10.1002/bjs.7115
Vassiliou MC, Feldman LS, Andrew CG, Bergman S, Leffondré K, Stanbridge D & Fried GM (2005). A global assessment tool for evaluation of intraoperative laparoscopic skills. Am J Surg. 190, 107–13 DOI: https://doi.org/10.1016/j.amjsurg.2005.04.004
Vassiliou MC, Kaneva PA, Poulose BK, Dunkin BJ, Marks JM, Sadik R, Sroka G, Anvari M, Thaler K, Adrales GL, Hazey JW, Lightdale JR, Velanovich V, Swanstrom LL, Mellinger JD & Fried GM (2010). Global assessment of gastrointestinal endoscopic skills (GAGES): A valid measurement tool for technical skills in flexible endoscopy. Surg Endosc Other Interv Tech. 24, 1834–41 DOI: https://doi.org/10.1007/s00464-010-0882-8
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