Nadel F M, Lavelle J M, Fein J A, Giardino A P, Decker J M, Durbin D R
Department of Pediatrics, The Children's Hospital of Philadelphia, University of Pennsylvania School of Medicine, 19104, USA.
Pediatr Emerg Care. 2000 Apr;16(2):73-6. doi: 10.1097/00006565-200004000-00001.
To describe pediatric housestaff knowledge, experience, confidence in pediatric resuscitations and their ability to perform important resuscitation procedures during the usual training experience.
Cohort study of PGY-3 level residents in a ACGME accredited pediatric residency training program at a large, tertiary care children's hospital.
Fund of knowledge was assessed by administering the standardized test from the Pediatric Advanced Life Support (PALS) Course in addition to a supplemental short answer test requiring clinical problem-solving skills. Procedural skills were evaluated through observation of the resident performing four procedures during a skills workshop using a weighted step-wise grading sheet. Resident experience and confidence was quantified using an anonymous survey.
Ninety-seven percent of residents participated. Residents achieved high scores on the standardized PALS test (93.2%+/-5.5), but performed less well when answering more complicated questions (60.0%+/-9.9) on the short answer test. No resident was able to successfully perform both basic and advanced airway skills, and only 11% successfully completed both vascular skills. Although residents were overall confident in their resuscitation skills, performance in the skill workshop revealed significant deficits. For example, only 18% performed ancillary airway maneuvers properly. None of the residents performed all four skills correctly. Experience in both real and mock resuscitations was infrequent. Residents reported receiving feedback on their performance less than half of the time. Over 89% of them felt that resuscitation knowledge and skill were important for their future chosen career.
Pediatric residents infrequently lead or participate in real or mock resuscitations. Although confident in performing many of the necessary resuscitation skills, few residents performed critical components of these skills correctly. Current pediatric residency training may not provide sufficient experience to develop adequate skills, fund of knowledge, or confidence needed for resuscitation.
描述儿科住院医师在常规培训期间对儿科复苏的知识、经验、信心以及他们执行重要复苏程序的能力。
对一家大型三级儿童专科医院中经美国毕业后医学教育认证委员会（ACGME）认可的儿科住院医师培训项目的三年级住院医师进行队列研究。
除了一项要求具备临床解决问题能力的补充简答题测试外，通过进行儿科高级生命支持（PALS）课程的标准化测试来评估知识储备。在技能研讨会上，使用加权逐步评分表观察住院医师执行四项程序的情况，以此评估操作技能。通过匿名调查对住院医师的经验和信心进行量化。
97%的住院医师参与了研究。住院医师在PALS标准化测试中取得了高分（93.2%±5.5），但在简答题测试中回答更复杂问题时表现较差（60.0%±9.9）。没有住院医师能够成功完成基本气道技能和高级气道技能，只有11%的人成功完成了两项血管技能。尽管住院医师总体上对自己的复苏技能有信心，但在技能研讨会上的表现显示出明显不足。例如，只有18%的人正确执行了辅助气道操作。没有住院医师四项技能全部正确执行。实际和模拟复苏的经验都很少。住院医师报告说，他们不到一半的时间能收到关于自己表现的反馈。超过89%的人认为复苏知识和技能对他们未来选择的职业很重要。
儿科住院医师很少主导或参与实际或模拟复苏。尽管对执行许多必要的复苏技能有信心，但很少有住院医师能正确执行这些技能的关键部分。目前的儿科住院医师培训可能无法提供足够的经验来培养复苏所需的足够技能、知识储备或信心。
