Nadel F M, Lavelle J M, Fein J A, Giardino A P, Decker J M, Durbin D R
The Children's Hospital of Philadelphia, Division of Emergency Medicine, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104.
Arch Pediatr Adolesc Med. 2000 Oct;154(10):1049-54. doi: 10.1001/archpedi.154.10.1049.
To evaluate the effectiveness of an educational intervention on pediatric residents' resuscitation fund of knowledge, technical skills, confidence, and overall performance.
Prospective, nonconcurrent, controlled interventional trial.
Urban pediatric tertiary care hospital.
An intervention group (IG) of 28 pediatric residents graduating in 1997, and a control group (CG) of 30 pediatric residents graduating in 1996.
Resuscitation course with didactic lectures and skills practice stations, as well as a minimum of 3 practice mock resuscitations with immediate feedback throughout postgraduate year 3.
Fund of knowledge, using the Pediatric Advanced Life Support test and short answer test; technical skills, using the Airway and Vascular Access Skills Assessment; experience and confidence, using an anonymous survey; and overall performance, evaluated using a videotaped mock resuscitation test.
The IG scored better on the short answer test (P<.001). A larger number of IG residents were successful in the completion of ancillary airway maneuvers and femoral vascular access (P =.02), as well as endotracheal intubation (P =.004) and intraosseous access (P =.002). The IG was more confident in their leadership role (P =.0001) and technical skills (P =.05). Trends toward improved overall performance were noted for the IG mock resuscitations. Residents in the IG were more likely to assess the airway in fewer than 2 minutes (P =.02), recognize the threat to life in fewer than 5 minutes (P =.02), and complete the primary survey in a timely fashion (P =.05). They required fewer prompts (P =.04) and made fewer mistakes (P =.07).
A structured, formal curriculum can improve the necessary fund of knowledge, skills, confidence, and leadership required for resuscitation.
评估一项教育干预措施对儿科住院医师复苏知识储备、技术技能、信心及整体表现的效果。
前瞻性、非同期、对照干预试验。
城市儿科三级护理医院。
28名1997年毕业的儿科住院医师组成的干预组（IG），以及30名1996年毕业的儿科住院医师组成的对照组（CG）。
开展包含理论讲座和技能练习站的复苏课程，以及在研究生三年级期间至少进行3次模拟复苏练习并即时给予反馈。
知识储备，采用儿科高级生命支持测试和简答题测试；技术技能，采用气道和血管通路技能评估；经验和信心，采用匿名调查；整体表现，通过录像模拟复苏测试进行评估。
干预组在简答题测试中得分更高（P<0.001）。更多干预组住院医师成功完成辅助气道操作和股血管穿刺（P = 0.02），以及气管插管（P = 0.004）和骨髓腔内穿刺（P = 0.002）。干预组在领导角色（P = 0.0001）和技术技能方面（P = 0.05）更有信心。干预组模拟复苏呈现出整体表现改善的趋势。干预组住院医师更有可能在不到2分钟内评估气道（P = 0.02），在不到5分钟内识别生命威胁（P = 0.02），并及时完成初级评估（P = 0.05）。他们需要的提示更少（P = 0.04），犯错更少（P = 0.07）。
结构化的正规课程可以提高复苏所需的知识储备、技能、信心和领导能力。
