Gordon David Lee, Issenberg S Barry, Gordon Michael S, LaCombe David, McGaghie William C, Petrusa Emil R
University of Miami Center for Research in Medical Education, Florida 33101, USA.
Med Teach. 2005 Mar;27(2):114-21. doi: 10.1080/01421590400029756.
Since appropriate treatment of patients in the first few hours of ischemic stroke may decrease the risk of long-term disability, prehospital providers should recognize, assess, manage and communicate about stroke patients in an effective and time-efficient manner. This requires the instruction and evaluation of a wide range of competencies including clinical skills, patient investigation and management and communication skills. The authors developed and assessed the effectiveness of a simulation-enhanced stroke course that incorporates several different learning strategies to evaluate competencies in the care of acute stroke patients. The one-day, interactive, emergency stroke course features a simulation-enhanced, blended-learning approach that includes didactic lectures, tabletop exercises, and focused-examination training and small-group sessions led by paramedic instructors as standardized patients portraying five key neurological syndromes. From January to October 2000, 345 learners were assessed using multiple-choice tests as were randomly selected group of 73 learners using skills' checklists during two pre- and two post-course simulated patient encounters. Among all learners there was a significant gain in knowledge (pre: 53.9%+/-13.9 and post: 85.4%+/-8.5; p<0.001), and for the 73 learners a significant improvement in their clinical and communication skills (p<0.0001 for all). By using a simulation-enhanced, blended-learning approach, pre-hospital paraprofessionals were successfully trained and evaluated in a wide range of competences that will lead to the more improved recognition and management of acute stroke patients.
由于在缺血性中风的最初几个小时内对患者进行适当治疗可能会降低长期残疾的风险，因此院前急救人员应以有效且高效的方式识别、评估、管理中风患者并进行沟通。这需要对包括临床技能、患者调查与管理以及沟通技能在内的广泛能力进行指导和评估。作者开发并评估了一个模拟强化中风课程的有效性，该课程采用了多种不同的学习策略来评估急性中风患者护理中的能力。这个为期一天的互动式紧急中风课程采用模拟强化的混合学习方法，包括理论讲座、桌面练习、重点检查培训以及由护理人员讲师带领的小组讨论，同时标准化患者会模拟五种关键的神经综合征。在2000年1月至10月期间，对345名学习者进行了多项选择题测试评估，另外在课程前后各两次模拟患者接诊期间，随机抽取了73名学习者使用技能清单进行评估。在所有学习者中，知识水平有显著提高（课前：53.9%±13.9，课后：85.4%±8.5；p<0.001），对于73名学习者来说，他们的临床和沟通技能有显著改善（所有p<0.0001）。通过采用模拟强化的混合学习方法，院前辅助专业人员在广泛的能力方面得到了成功培训和评估，这将有助于更好地识别和管理急性中风患者。
