Birch L, Jones N, Doyle P M, Green P, McLaughlin A, Champney C, Williams D, Gibbon K, Taylor K
Practice Development and Research Unit, Duchess of Westminster Wing, Arrowe Park Hospital, Upton, Wirral, Cheshire CH49 5PE, United Kingdom.
Nurse Educ Today. 2007 Nov;27(8):915-22. doi: 10.1016/j.nedt.2007.01.006. Epub 2007 Mar 21.
To determine the most effective method of delivering training to staff on the management of an obstetric emergency.
The research was conducted in a District General Hospital in the UK, delivering approximately 3500 women per year. Thirty-six staff, comprising of junior and senior medical and midwifery staff were included as research subjects. Each of the staff members were put into one of six multi-professional teams. Effectively, this gave six teams, each comprising of six members.
Three teaching methods were employed. Lecture based teaching (LBT), simulation based teaching (SBT) or a combination of these two (LAS). Each team of staff were randomly allocated to undertake a full day of training in the management of Post Partum Haemorrhage utilising one of these three teaching methods. Team knowledge and performance were assessed pre-training, post training and at three months later. In addition to this assessment of knowledge and performance, qualitative semi-structured interviews were carried out with 50% of the original cohort one year after the training, to explore anxiety, confidence, communication, knowledge retention, enjoyment and transferable skills.
All teams improved in their performance and knowledge. The teams taught using simulation only (SBT) were the only group to demonstrate sustained improvement in clinical management of the case, confidence, communication skills and knowledge. However, the study did not have enough power to reach statistical significance. The SBT group reported transferable skills and less anxiety in subsequent emergencies. SBT and LAS reported improved multidisciplinary communication. Although tiring, the SBT was enjoyed the most.
Obstetrics is a high risk speciality, in which emergencies are to some extent, inevitable. Training staff to manage these emergencies is a fundamental principal of risk management. Traditional risk management strategies based on incident reporting and event analysis are reactive and not always effective. Simulation based training is an appropriate proactive approach to reducing errors and risk in obstetrics, improving teamwork and communication, whilst giving the student a multiplicity of transferable skills to improve their performance.
确定向工作人员提供产科紧急情况管理培训的最有效方法。
该研究在英国一家地区综合医院进行，每年接生约3500名妇女。三十六名工作人员，包括初级和高级医疗及助产人员被纳入研究对象。每名工作人员被分到六个多专业团队中的一个。实际上，这形成了六个团队，每个团队由六名成员组成。
采用三种教学方法。基于讲座的教学（LBT）、基于模拟的教学（SBT）或两者结合（LAS）。每个工作人员团队被随机分配，使用这三种教学方法之一参加一整天的产后出血管理培训。在培训前、培训后和三个月后对团队知识和表现进行评估。除了对知识和表现进行评估外，在培训一年后，对原研究对象的50%进行定性半结构化访谈，以探讨焦虑、信心、沟通、知识保留、乐趣和可转移技能。
所有团队的表现和知识都有所提高。仅采用模拟教学（SBT）的团队是唯一在病例临床管理、信心、沟通技巧和知识方面持续改善的组。然而，该研究没有足够的效力达到统计学显著性。SBT组报告了可转移技能以及在后续紧急情况中焦虑较少。SBT组和LAS组报告多学科沟通有所改善。尽管很累，但SBT是最受欢迎的。
产科是一个高风险专业，在某种程度上，紧急情况不可避免。培训工作人员管理这些紧急情况是风险管理的基本原则。基于事件报告和事件分析的传统风险管理策略是被动的，并不总是有效。基于模拟的培训是一种适当的主动方法，可减少产科中的错误和风险，改善团队合作和沟通，同时赋予学生多种可转移技能以提高其表现。
