Marshall R L, Smith J S, Gorman P J, Krummel T M, Haluck R S, Cooney R N
Department of Surgery, The Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, Pennsylvania 17033, USA.
J Trauma. 2001 Jul;51(1):17-21. doi: 10.1097/00005373-200107000-00003.
Computerized human patient simulators (HPSs) have been used to improve diagnostic and therapeutic decision making. The goal of this study was to investigate the impact of HPSs and Advanced Trauma Life Support (ATLS) on the development of trauma management skills and self-confidence in surgical interns.
Three teams of interns completed two ATLS-like trauma scenarios on the HPS (pre-ATLS). They then took the ATLS provider course. After ATLS, the interns were evaluated on two different HPS trauma scenarios (post-ATLS). Two teams of senior residents, experienced in trauma care, completed the same HPS scenarios and were used as controls. Trauma management skills were scored in three areas--critical treatment decisions, potential for adverse outcomes, and team behavior--by staff trauma surgeons. After participating in the HPS trauma scenarios, the interns completed self-confidence questionnaires and a course evaluation survey.
Trauma management skill scores increased 23% in critical treatment decisions, 25% in potential for adverse outcomes, and 47% in team behavior after ATLS/HPS (p < 0.002). Senior residents' performance on HPS trauma scenarios was better than the interns (p < 0.05) in all three areas evaluated. The interns' self-confidence scores rose significantly after the course. (p < 0.01) The HPS course evaluation survey averaged 8.3 out of a maximum 10.
Use of HPSs in conjunction with ATLS appears to enhance the development of trauma management skills. The surgical interns participating in the study deemed the HPS to be a worthwhile experience and a confidence-building tool. In particular, trauma team behavior improved significantly after ATLS/HPS.
计算机化人体患者模拟器（HPS）已被用于改善诊断和治疗决策。本研究的目的是调查HPS和高级创伤生命支持（ATLS）对外科实习医生创伤管理技能发展和自信心的影响。
三组实习医生在HPS上完成了两个类似ATLS的创伤场景（ATLS前）。然后他们参加了ATLS提供者课程。ATLS培训后，实习医生在两个不同的HPS创伤场景中接受评估（ATLS后）。两组有创伤护理经验的高年资住院医师完成了相同的HPS场景，并作为对照组。创伤管理技能在三个方面进行评分——关键治疗决策、不良后果可能性和团队行为——由创伤外科医生进行评估。在参与HPS创伤场景后，实习医生完成了自信心问卷和课程评估调查。
在ATLS/HPS培训后，关键治疗决策方面的创伤管理技能得分提高了23%，不良后果可能性方面提高了25%，团队行为方面提高了47%（p<0.002）。在所有三个评估领域中，高年资住院医师在HPS创伤场景中的表现均优于实习医生（p<0.05）。课程结束后，实习医生的自信心得分显著提高（p<0.01）。HPS课程评估调查平均得分为8.3分（满分10分）。
将HPS与ATLS结合使用似乎能促进创伤管理技能的发展。参与研究的外科实习医生认为HPS是一次有价值的经历和一种增强自信心的工具。特别是，在ATLS/HPS培训后，创伤团队行为有了显著改善。
