Youngblood Patricia, Harter Phillip M, Srivastava Sakti, Moffett Shannon, Heinrichs Wm LeRoy, Dev Parvati
Stanford University Medical Media and Information Technologies (SUMMIT), Department of Surgery, Stanford University, Stanford, CA, USA.
Simul Healthc. 2008 Fall;3(3):146-53. doi: 10.1097/SIH.0b013e31817bedf7.
Training interdisciplinary trauma teams to work effectively together using simulation technology has led to a reduction in medical errors in emergency department, operating room, and delivery room contexts. High-fidelity patient simulators (PSs)-the predominant method for training healthcare teams-are expensive to develop and implement and require that trainees be present in the same place at the same time. In contrast, online computer-based simulators are more cost effective and allow simultaneous participation by students in different locations and time zones. In this pilot study, the researchers created an online virtual emergency department (Virtual ED) for team training in crisis management, and compared the effectiveness of the Virtual ED with the PS. We hypothesized that there would be no difference in learning outcomes for graduating medical students trained with each method.
In this pilot study, we used a pretest-posttest control group, experimental design in which 30 subjects were randomly assigned to either the Virtual ED or the PS system. In the Virtual ED each subject logged into the online environment and took the role of a team member. Four-person teams worked together in the Virtual ED, communicating in real time with live voice over Internet protocol, to manage computer-controlled patients who exhibited signs and symptoms of physical trauma. Each subject had the opportunity to be the team leader. The subjects' leadership behavior as demonstrated in both a pretest case and a posttest case was assessed by 3 raters, using a behaviorally anchored scale. In the PS environment, 4-person teams followed the same research protocol, using the same clinical scenarios in a Simulation Center. Guided by the Emergency Medicine Crisis Resource Management curriculum, both the Virtual ED and the PS groups applied the basic principles of team leadership and trauma management (Advanced Trauma Life Support) to manage 6 trauma cases-a pretest case, 4 training cases, and a posttest case. The subjects in each group were assessed individually with the same simulation method that they used for the training cases.
Subjects who used either the Virtual ED or the PS showed significant improvement in performance between pretest and posttest cases (P < 0.05). In addition, there was no significant difference in subjects' performance between the 2 types of simulation, suggesting that the online Virtual ED may be as effective for learning team skills as the PS, the method widely used in Simulation Centers. Data on usability and attitudes toward both simulation methods as learning tools were equally positive.
This study shows the potential value of using virtual learning environments for developing medical students' and resident physicians' team leadership and crisis management skills.
利用模拟技术培训跨学科创伤团队以使其有效协作，已使急诊科、手术室和产房环境中的医疗差错有所减少。高保真患者模拟器（PSs）——培训医疗团队的主要方法——开发和实施成本高昂，且要求学员在同一时间身处同一地点。相比之下，基于计算机的在线模拟器成本效益更高，允许不同地点和时区的学生同时参与。在这项试点研究中，研究人员创建了一个用于危机管理团队培训的在线虚拟急诊科（Virtual ED），并将Virtual ED与PS的有效性进行了比较。我们假设，用这两种方法培训的即将毕业的医学生在学习成果上不会有差异。
在这项试点研究中，我们采用了前测-后测对照组实验设计，将30名受试者随机分配到Virtual ED或PS系统。在Virtual ED中，每个受试者登录在线环境并扮演团队成员的角色。四人团队在Virtual ED中共同协作，通过互联网协议实时进行语音交流，以管理表现出身体创伤体征和症状的计算机控制患者。每个受试者都有机会担任团队领导。由3名评分者使用行为锚定量表对受试者在前测案例和后测案例中表现出的领导行为进行评估。在PS环境中，四人团队遵循相同的研究方案，在模拟中心使用相同的临床场景。在急诊医学危机资源管理课程的指导下，Virtual ED组和PS组都应用团队领导和创伤管理（高级创伤生命支持）的基本原则来处理6个创伤案例——一个前测案例、4个培训案例和一个后测案例。每组受试者都使用与培训案例相同的模拟方法进行单独评估。
使用Virtual ED或PS的受试者在前测和后测案例之间的表现均有显著改善（P < 0.05）。此外，两种模拟类型的受试者表现没有显著差异，这表明在线Virtual ED在学习团队技能方面可能与PS同样有效，PS是模拟中心广泛使用的方法。关于两种模拟方法作为学习工具的可用性和态度的数据同样积极。
本研究显示了使用虚拟学习环境培养医学生和住院医师团队领导及危机管理技能的潜在价值。
