| Background & ObjectiveEndoscopes are often used in the diagnosis and therapy of various urological diseases. Because it is an invasive operation, the accuracy and proficiency of operators’ operating practices are highly required. Traditionally, endoscope operating skills are passed on to beginners through the mode of “apprenticeship”, i.e., watching and learning the skills from superior doctors’ words and deeds, gathering technical experience, and gradually practicing operations from the simple to the complex. However, this learning mode would bring medical safety problems when the beginners conduct endoscope operations, and cannot guarantee enough opportunities and time for beginners to practice, considering the fact that the ability of independently operating endoscope can only be obtained by long-term learning and practicing. Therefore, it is of great significance to explore a safe, effective, and specific way of training endoscope operations. This study aimed to design and make a “urinary system model with functional bladder module”, which has the anatomical structure similar to the organs of human urinary system and can simulate human bladder’s urine storage and discharge functions. This study took this model as the training platform, and assessed the effect of the URL(ureteroscope lithotripsy) skill training carried out on this platform.Research Methods1.Design of the Model’s Functions and Structure(1)Taking human urinary system’s physiological processes of urine storage and discharge as reference, it designed a plan of imitating human urinary organs’ urine storage and discharge processes based on the existing technical conditions, and based on the plan, worked out the schematic diagram.(2)According to the schematic diagram and the anatomical data of male urinary organs, it determined the design parameters of all the components of the model, and then carried out the modelling design by using Rhino 4.0 and structure design by using UGNX scores of each group were recorded as ±S. Independent sample, t-test, was used to compare the measurement date of the groups, and a p value less than 0.05 was accepted as statistically significant(SPSS 19.0 Windows; by spass 19.0 software package).Results1.The design and manufacture were finished according to the requirements. The structure of each component, the bladder’s pressure function and controllable urine discharging function met the design requirements.2.After group A and B received a 10-days learning through the “apprenticeship mode” and “model method” respectively, the assessment results are as follows:(1)Step score: the students from both the groups finished the 6 steps correctly and thus gained 6 points.(2)Quality score: group A(20.2±4.3), group B(24.5±3.9);(p = 0.031).ConclusionAfter group A and B separately learned URL skills through the “apprenticeship mode” and “model method” respectively and were assessed by using a same model, the results showed that the effect of the “model”-based training method is obviously better than that of the “apprenticeship mode”. The results confirm that applying the “model” to the skill training of urological endoscope operations can help to improve beginners’ operating skills and thus shorten the curve of their learning endoscope operations. 7.5.2.Model Making(1)Data was set on the basis of UG/CAD modeling software, and the outer part of the model was made by using rapid prototyping technology and taking PMMA as raw material. Then, master mold was made by CNC machines on the basis of UG-CAM numerical control programming, and the inner part of the model was made with natural emulsion as its raw material. All the components of the model were put together, and the auxiliary devices were added. Then, the performance of the model was tested.(2)All the components of the model were put together, and the auxiliary devices were added. Then, the performance of the model was tested, mainly including the artificial bladder’s pressure function and controllable “urine discharging” function.3.Training with the Model(1)Carrying out URL simulated training based on the model: 20 graduate students in the same grade, who had never conducted ureteroscope operations before, were chosen to receive a 6-hour theoretical training on ureteroscope. Then, the 20 students were divided into A and B groups randomly, which were intended to learn URL in different ways. Group A learned URL skills through the traditional “apprenticeship” mode, while group B received the training on the platform of the model. Ten days later, the students from both the groups were assessed with a newly-made pig kidney/ureter model.(2)The students were required to independently complete all the URL processes and their performance was assessed. The judges graded the six key steps in the URL operation(including cystoscopy, finding the opening of the ureter, inserting the guide wire into the ureter, identifying urethral stones, using the lithotripter to break the stones, and using basket extractor to remove the broken stones and removing ureteroscope) according to an objective standard for assessment. The students would score 1 point every time they finished one step correctly, and gain no point if they failed. Additionally, to the students who finished all the 6 steps correctly, a quality grading system was used to assess their operation quality. This system included 7 assessment items, including patient-friendly consciousness during operation, use of instruments, cooperation with assistants, efficiency, instrument knowledge, operation procedure, and knowledge on the procedure and treatments for complications. A scale from 1 to 5(1-5 points) was set for each item, and thus the total score was 35. The... |
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