Modelo sintético e de baixo custo para treinamento de hernioplastia inguinal aberta / Synthetic and low cost model for open inguinal hernioplasty training

As hérnias inguinais representam 69% dos casos de hérnias abdominais e sua reparação, a hernioplastia, é o procedimento mais realizado em Cirurgia Geral. Tendo em vista esse fato e que simuladores de baixo custo vêm ganhando cada vez mais espaço na graduação Médica devido aos aspectos éticos envolvendo o treinamento com pacientes reais e animais, nosso estudo objetivou a confecção de modelo sintético inédito, reprodutíveis e de baixo custo para o treinamento na técnica de hernioplastia inguinal aberta. Desse modo, com materiais de fácil acesso e preço reduzido, conseguimos construir com R$ 44,12 reais (US$ 14,27) o simulador proposto, podendo ser utilizado em cursos e aulas teórico-práticas com o intuito de demonstrar o procedimento de hernioplastia inguinal. (AU)

Inguinal hernias represent 69% of the cases of abdominal hernias and their repair is the most accomplished procedure in General Surgery. Considering this fact and that low cost simulators have been gaining more space in medical graduation due to the ethical aspects involved in the training of real and animal patients, our study aimed at the creation of a synthetic, unpublished, reproducible and low cost model for the Training in the technique of open inguinal hernioplasty. Thus, with easy-access materials and reduced price, we were able to construct with US$ 14,27 the proposed simulator, being able to be used in courses and theoretical-practical classes with the purpose of demonstrating the inguinal hernioplasty procedure. (AU)

Systematic training model for teaching, development and training of instructors in inguinal hernia treatment using the Lichtenstein technique. Hernia campaign 2014 & 2015. / Modelo de treinamento sistematizado para o ensino, desenvolvimento e formação de instrutores no tratamento da hérnia inguinal pela técnica de Lichtenstein. Mutirão da hérnia 2014 e 2015.

ABSTRACT Objective: to evaluate the method of training and continuing education of 18 surgeons in 2014, and 28 surgeons in 2015, in the Holy Homes of Ribeirao Preto, Araraquara, Franca and San Carlos of São Paulo, in the performance of Lichtenstein inguinal herniorrhaphy, tutored by the Faculty of Medical Sciences of the São Paulo Holy Home and the organization HERNIA HELP - "Hernia Repair for the Underserved". Methods: the training was tutored and systematized through an active methodology of teaching and learning, aiming to offer competence, skills and attitudes, measured by a previously validated Qualification Form, qualifying leaders in trainees' improvement. Results: in 2014 the outcomes were: the difficulty of the case, direction, incision, dissection, mesh preparation, mesh cutting, mesh setting, closing, instruments, respect to tissues, flow, time and motion, and performance, all presented change in the general rating (p=0.000002); there was greater confidence in the execution of the procedure in 80% of trainees, considered "very valuable" in 93.3% of the interventions. In 2015, 28 surgeons were trained by ten surgeons previously qualified in 2014. The nerve identification rate, a relevant time the Lichtenstein technique, was 95.5% for the Iliohypogastric, 98.5% for the ilioinguinal and 89.4% for the genital branch of the genitofemoral nerve. Conclusion: the applied teaching method is possible, reproducible, reliable and valid. The joint efforts offer enormous opportunity of directed education, reaching underserved populations, revealing the great teacher-student social responsibility.

RESUMO Objetivo: avaliar resultados do método de treinamento e educação continuada de 18 cirurgiões, em 2014, e 28 cirurgiões, em 2015, nas Santas Casas de Ribeirão Preto, Araraquara, Franca e São Carlos do Estado de São Paulo, na realização da Herniorrafia Inguinal à Lichtenstein, tutorados pela Faculdade de Ciências Médicas da Santa Casa de São Paulo e pela organização HERNIA HELP - "Hernia Repair for the Underserved". Métodos: treinamento tutorado e sistematizado, através de metodologia ativa de ensino e aprendizagem, visando a oferecer competência, habilidade e atitudes, auferidas por um Formulário de Qualificação previamente validado, qualificando líderes no aperfeiçoamento de treinandos. Resultados: em 2014, os desfechos foram: dificuldade do caso, direção, incisão, dissecção, preparo da tela, corte da tela, fixação da tela, fechamento, instrumentos, respeito aos tecidos, fluxo, tempo e movimento e desempenho, apresentaram mudança na Classificação Geral (p=0,000002); houve maior confiança na execução do procedimento em 80% dos treinandos, sendo considerado "Muito Valioso" em 93,3% das participações. Em 2015, os 28 cirurgiões foram treinados por dez cirurgiões previamente qualificados em 2014. A taxa de identificação dos nervos, tempo relevante da técnica de Lichtenstein, foi 95,5 % para o ílio-hipogástrico, 98,5% para o ilioinguinal e 89,4% para o ramo genital do nervo genitofemoral. Conclusão: o método de ensino aplicado é possível, reprodutível, confiável e válido. Os mutirões oferecem a enorme oportunidade do ensino, dirigido, atingindo populações carentes, revelando a grande responsabilidade social docente-discente.

Evaluación objetiva de competencias técnicas en cirugía / [Evaluation of technical skills in surgical training].

INTRODUCTION: technical skills acquisition is considered to be of paramount importance in surgical training. Yet, formal assessment of technical skills is the weakest and less developed area. Currently available resources to evaluate technical skills are largely subjective, and lack of validity and reliability. Direct observation, one of the most frequently used methods, is largely biased by interpersonal subjectivity and personality traits. We propose the creation and use of a new procedure-specific tool for objective assessment of technical skills in surgery to evaluate validity and reliability. MATERIALS AND METHODS: laparoscopic cholecystectomy and Lichstenstein’s inguinal hernia repair were the chosen procedures. Three groups of comparison were defined according to surgical expertise: initial, intermediate, and experts. Surgeries were videorecorded in real time without identification of the patient or the surgeon. Tapes without any posterior edition were assigned to two expert surgeons in a blind and randomized sequence. A newly proposed procedure-specific rating scale was used for evaluation, as well as Reznick’s OSATS global scale. Kruskal-Wallis non-parametric test was used to assess validity. p 0.8 granted reliability. RESULTS: from April 2010 to December 2012 36 laparoscopic cholecystectomies and 31 inguinal hernia repairs were recorded. Significant difference was found among groups of comparison for every item (p<0.05). Crhonbach’s ? was largely over 0,80 for both procedures. There was no significant difference between the assessments of the two raters. There was no significant difference between our newly proposed procedure-specific instrument and Reznick’s OSTATS. DISCUSSION: the objective assessment of technical skills in surgery is feasible and useful. The tool we proposed showed construct validity and reliability. Video recording of surgical procedures grants durability over time to an ephemeral phenomenon. The objectivity is based on the explicit statements and quantification of every step to be evaluated, and the blind randomization and anonymous treatment of the sample. Sharing the same quality criteria between evaluators is of paramount importance to reach satisfactory results. The process of evaluation always implies a shortened view of the reality.