Summerhill Eleanor M, Mathew Milan C, Stipho Sally, Artenstein Andrew W, Jagminas Liudvikas, Russo-Magno Patricia M, Potter Susan, Shapiro Marc J
Internal Medicine Residency Program, Department of Medicine, Memorial Hospital of Rhode Island, Pawtucket, RI 02860, USA.
Med Teach. 2008;30(6):e145-51. doi: 10.1080/01421590802047257.
Disaster and bioterrorism preparedness is poorly integrated into the curricula of internal medicine residency programs. Given that victims may present to a variety of healthcare venues, including primary care practices, inpatient hospital wards, and intensive care units, we developed a curriculum to address this need.
The curriculum consisted of four didactic sessions with supplemental readings covering biologic, chemical, and radiologic agents, as well as public health infrastructure. All 30 internal medicine resident participants also underwent a four hour training seminar at a high fidelity human simulation center. Instruction included the use of personal protective equipment (PPE)and participation in simulated scenarios utilizing technologically sophisticated mannequins with monitoring and interactive capability. Sessions were videotaped, reviewed with participants, and followed by self-evaluation and constructive feedback.
Compared to a control group of residents who did not undergo training, the participants' level of knowledge was significantly better, with mean objective test scores of 66.8%+/-11.8% SD vs. 50%+/-13.1% SD, p < 0.0001. Although there was a trend toward increasing knowledge with increasing level of training in the control group, this difference was not significant. Subjective preparedness was also significantly better in the intervention group (p < 0.0001). Objective improvements were not maintained after one year.
In this pilot study, a disaster-preparedness curriculum including simulation-based training had a positive effect on residents' knowledge base and ability to respond to disaster. However, this effect had diminished after one year, indicating the need for reinforcement at regular intervals.
灾难和生物恐怖防范措施在住院医师内科培训课程中整合得很差。鉴于受害者可能会前往各种医疗场所，包括初级保健机构、住院病房和重症监护病房，我们制定了一门课程来满足这一需求。
该课程包括四个授课环节，并配有补充读物，内容涵盖生物、化学和放射制剂以及公共卫生基础设施。所有30名内科住院医师参与者还在一个高仿真人体模拟中心参加了为期四小时的培训研讨会。培训内容包括个人防护装备（PPE）的使用，以及利用具有监测和交互功能的技术先进的人体模型参与模拟场景。培训环节进行了录像，与参与者一起回顾，并随后进行自我评估和建设性反馈。
与未接受培训的住院医师对照组相比，参与者的知识水平明显更高，客观测试平均成绩为66.8%±11.8%标准差，而对照组为50%±13.1%标准差，p<0.0001。尽管对照组中随着培训水平的提高知识有增加的趋势，但这种差异并不显著。干预组的主观防范能力也明显更好（p<0.0001）。一年后客观改善情况未得到维持。
在这项试点研究中，包括基于模拟的培训在内的灾难防范课程对住院医师的知识库和应对灾难的能力产生了积极影响。然而，这种影响在一年后有所减弱，表明需要定期强化。
