Azcona Luis Am, Gutierrez Guillermo E O, Fernandez Cesar J P, Natera Octavio M, Ruiz-Speare Octavio, Ali Jameel
The Military Hospital, Mexico City, Mexico.
J Am Coll Surg. 2002 Sep;195(3):372-7. doi: 10.1016/s1072-7515(02)01206-1.
Mexico has had the Advanced Trauma Life Support (ATLS) program since 1986. We assessed the attrition of ATLS skills among ATLS providers and instructors in this country.
Three groups (S, 16 students [new medical graduates enrolled for an ATLS course]; P, 33 providers; and I, 26 instructors [who had completed courses previously]) were evaluated. Group S read the manual before pretesting. Groups P and I were subdivided based on the length of time since the course had been completed: P1, less than 2 years (n = 22); P2, more than 2 years (n = 11); I1, less than 2 years (n = 16); and I2, more than 2 years (n = 10). Multiple-choice and psychomotor testing using ATLS scoring criteria were used. Affect was assessed post-ATLS for motivational factors, interactivity, and attitude toward trauma care.
Multiple-choice test scores (means +/- SD) out of a maximum of 40 were as follows: S, 24.3 +/- 2.6; P1, 24.0 +/- 5.7; P2, 21.3 +/- 8.0; I1, 23.2 +/- 8.2; and I2, 24.0 +/- 7.2. Group S all passed the post-ATLS multiple-choice test (with correct answer percentages of 60.3% +/- 6.6% pre-ATLS versus 88.8% +/- 5.6% post-ATLS). An ATLS passing score of 80% correct answers was achieved in 2 of 33 for group P and 8 of 26 for group I (p < 0.05), with no statistically significant differences between groups P1 and P2 or between groups I1 and I2. For the psychomotor skills testing component, 5 of 16 in the S group passed, 15 of 22 in P1 passed, 9 of 11 in P2 passed, 14 of 16 in I1 passed, and 6 of 10 in I2 passed. The pass rate was significantly lower in the S pre-ATLS group than in the P and I groups (p < 0.05, Fisher's exact test). More than 60% preferred interactive components and enrolled for professional improvement, and more than 90% reported improved post-ATLS attitude to trauma care.
Reading the manual alone yields similar cognitive but inferior psychomotor performance compared with subjects who completed the course previously. The majority of previous providers and instructors did not obtain a passing score (80%) in the multiple-choice test, but all the new providers passed the post-ATLS multiple-choice test, suggesting major attrition of cognitive skills but maintenance of psychomotor skills. Instructors had superior cognitive performance versus providers with worsening performance over time, but clinical skills performance was maintained at an equally high level by all groups. A very positive attitude toward ATLS prevailed among all participants.
墨西哥自1986年起开展了高级创伤生命支持（ATLS）项目。我们评估了该国ATLS提供者和教员的ATLS技能损耗情况。
对三组人员进行了评估（S组，16名学生[新入职的医学毕业生，报名参加ATLS课程]；P组，33名提供者；I组，26名教员[之前已完成课程]）。S组在预测试前阅读手册。P组和I组根据课程结束后的时间长短进一步细分：P1组，少于2年（n = 22）；P2组，超过2年（n = 11）；I1组，少于2年（n = 16）；I2组，超过2年（n = 10）。采用ATLS评分标准进行多项选择题和操作技能测试。在ATLS课程结束后，对动机因素、互动性和对创伤护理的态度等影响因素进行了评估。
多项选择题测试满分40分，得分（均值±标准差）如下：S组，24.3±2.6；P1组，24.0±5.7；P2组，21.3±8.0；I1组，23.2±8.2；I2组，24.0±7.2。S组所有人员均通过了ATLS课程后的多项选择题测试（ATLS课程前正确答案百分比为60.3%±6.6%，课程后为88.8%±5.6%）。P组33人中2人、I组26人中8人在多项选择题测试中达到了80%正确答案的及格分数（p < 0.05），P1组和P2组之间或I1组和I2组之间无统计学显著差异。对于操作技能测试部分，S组16人中5人通过，P1组22人中15人通过，P2组11人中9人通过，I1组16人中14人通过，I2组10人中6人通过。S组预测试前的通过率显著低于P组和I组（p < 0.05，Fisher精确检验）。超过60%的人更喜欢互动环节并报名参加专业进修，超过90%的人表示ATLS课程后对创伤护理的态度有所改善。
与之前完成课程的人员相比，仅阅读手册在认知方面表现相似，但操作技能表现较差。大多数之前的提供者和教员在多项选择题测试中未达到及格分数（80%），但所有新提供者均通过了ATLS课程后的多项选择题测试，这表明认知技能出现了较大损耗，但操作技能得以保持。教员的认知表现优于提供者，且随着时间推移表现变差，但所有组的临床技能表现均保持在同样较高的水平。所有参与者对ATLS都持有非常积极的态度。
