Olympio M A, Whelan R, Ford R P A, Saunders I C M
Department of Anesthesiology, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1009, USA.
Br J Anaesth. 2003 Sep;91(3):312-8. doi: 10.1093/bja/aeg183.
There are few scientific reports documenting the effects of simulation training on learning. Issues of scientific validity challenge investigators who measure such outcomes. We perceived a failure of residents to change their technical management of oesophageal intubation after simulation training and sought clarification of this observation.
Twenty-one residents were randomly exposed to two deliberate oesophageal intubation scenarios, first as a junior assistant (JS group) or as a senior managing resident (SS group), and secondly as a senior managing resident. After the first episode, residents were given an explanation and demonstration of the suggested technical management strategy, including: (i) confirmation of oesophageal intubation with a second direct laryngoscopy; and (ii) concurrent insertion of a second tube into the trachea. After the second episode, we retrospectively sought to confirm improvement in technical management within the SS group by measuring videotaped performances. Questionnaires were sent to the residents before and after reporting their performance results.
There were 14 SS and seven JS subjects. Within SS, there was no improvement in "confirmation of oesophageal intubation with direct laryngoscopy" (8/14 vs 9/14) or any improvement in "concurrent insertion of a second ETT (tracheal) tube" (1/14 vs 2/14). Questionnaire responses offered considerable insight into these negative results.
This failure to change may have been secondary to a lack of criterion validity, lack of repetition or a long duration between episodes. The expectations for management were not regarded as being advantageous in simulation, but they were successfully adopted in actual clinical emergencies.
关于模拟训练对学习效果影响的科学报告较少。科学有效性问题给测量此类结果的研究人员带来了挑战。我们发现住院医师在模拟训练后并未改变其食管插管的技术操作方式，因此寻求对这一观察结果的解释。
21名住院医师被随机安排参与两种故意设置的食管插管场景，首先作为初级助手（JS组）或高级主治住院医师（SS组），然后作为高级主治住院医师。在第一次操作后，向住院医师解释并演示了建议的技术操作策略，包括：（i）通过第二次直接喉镜检查确认食管插管；（ii）同时插入第二根气管导管。在第二次操作后，我们通过测量录像表现回顾性地确认SS组技术操作是否有所改进。在住院医师报告其操作结果前后向他们发送了问卷。
有14名SS组和7名JS组受试者。在SS组内，“通过直接喉镜检查确认食管插管”没有改善（8/14对9/14），“同时插入第二根气管导管（ETT）”也没有任何改善（1/14对2/14）。问卷回复为这些负面结果提供了相当多的见解。
这种未发生改变的情况可能是由于缺乏标准效度、缺乏重复或两次操作之间间隔时间过长。在模拟中，对操作的预期未被视为有利，但它们在实际临床紧急情况中被成功采用。
