Murray David J, Boulet John R, Avidan Michael, Kras Joseph F, Henrichs Bernadette, Woodhouse Julie, Evers Alex S
Washington University Clinical Simulation Center, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
Anesthesiology. 2007 Nov;107(5):705-13. doi: 10.1097/01.anes.0000286926.01083.9d.
Anesthesiologists and anesthesia residents are expected to acquire and maintain skills to manage a wide range of acute intraoperative anesthetic events. The purpose of this study was to determine whether an inventory of simulated intraoperative scenarios provided a reliable and valid measure of anesthesia residents' and anesthesiologists' skill.
Twelve simulated acute intraoperative scenarios were designed to assess the performance of 64 residents and 35 anesthesiologists. The participants were divided into four groups based on their training and experience. There were 31 new CA-1, 12 advanced CA-1, and 22 CA-2/CA-3 residents as well as a group of 35 experienced anesthesiologists who participated in the assessment. Each participant managed a set of simulated events. The advanced CA-1 residents, CA-2/CA-3 residents, and 35 anesthesiologists managed 8 of 12 intraoperative simulation exercises. The 31 CA-1 residents each managed 3 intraoperative scenarios.
The new CA-1 residents received lower scores on the simulated intraoperative events than the other groups of participants. The advanced CA-1 residents, CA-2/CA-3 residents, and anesthesiologists performed similarly on the overall assessment. There was a wide range of scores obtained by individuals in each group. A number of the exercises were difficult for the majority of participants to recognize and treat, but most events effectively discriminated among participants who achieved higher and lower overall scores.
This simulation-based assessment provided a valid method to distinguish the skills of more experienced anesthesia residents and anesthesiologists from residents in early training. The overall score provided a reliable measure of a participant's ability to recognize and manage simulated acute intraoperative events. Additional studies are needed to determine whether these simulation-based assessments are valid measures of clinical performance.
麻醉医生和麻醉住院医师需要掌握并维持应对各类术中急性麻醉事件的技能。本研究旨在确定一系列模拟术中场景是否能可靠且有效地评估麻醉住院医师和麻醉医生的技能。
设计了12个模拟术中急性场景，以评估64名住院医师和35名麻醉医生的表现。参与者根据其培训和经验分为四组。有31名新入职的CA - 1住院医师、12名进阶的CA - 1住院医师、22名CA - 2/CA - 3住院医师，以及一组35名经验丰富的麻醉医生参与了评估。每位参与者应对一组模拟事件。进阶的CA - 1住院医师、CA - 2/CA - 3住院医师和35名麻醉医生应对12个术中模拟练习中的8个。31名CA - 1住院医师每人应对3个术中场景。
新入职的CA - 1住院医师在模拟术中事件上的得分低于其他组的参与者。进阶的CA - 1住院医师、CA - 2/CA - 3住院医师和麻醉医生在整体评估中的表现相似。每组中个体的得分范围很广。许多练习对大多数参与者来说难以识别和处理，但大多数事件能有效区分整体得分较高和较低的参与者。
这种基于模拟的评估提供了一种有效的方法，可将经验更丰富的麻醉住院医师和麻醉医生与早期培训的住院医师的技能区分开来。整体得分提供了对参与者识别和处理模拟术中急性事件能力的可靠衡量。需要进一步研究以确定这些基于模拟的评估是否是临床绩效的有效衡量指标。
