Tubbs Robert J, Murphy Brian, Mainiero Martha B, Shapiro Marc, Kobayashi Leo, Lindquist David, Smith Jessica L, Siegel Nathan
Department of Emergency Medicine, Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island 02903, USA.
J Am Coll Radiol. 2009 Aug;6(8):582-7. doi: 10.1016/j.jacr.2009.04.012.
The aims of this study were to use medical simulation as an assessment tool for the evaluation of radiology residents' compliance with contrast reaction treatment protocols and to gauge their perceptions of the simulation experience.
A prospective, observational study of postgraduate year 2 and 3 radiology residents' management of simulated life-threatening contrast reactions was designed. After standard didactic teaching on departmental contrast reaction protocols, residents participated individually in high-fidelity medical simulations of acute contrast reactions. Residents' performance of predetermined critical actions was recorded. Presimulation and postsimulation multiple-choice testing evaluated residents' knowledge of departmental protocols. Each resident completed 5-point, Likert-type surveys assessing comfort level while managing contrast reactions and perceptions of the simulation experience.
Residents performed a mean of 13 of 20 critical actions (range, 10-16). The average presimulation multiple-choice testing score was 56%, whereas the average postsimulation score was 92% (P = .0003). Subjects' average ratings of comfort level in managing in-hospital contrast reactions before and after study intervention were 3.47 and 4.07, respectively (P = .03). Average ratings for comfort level in the outpatient setting were 3.08 before and 3.69 after the study (P = .69). All residents strongly agreed that the simulation was a valuable educational experience, while 85% strongly agreed that it improved their skills in managing acute contrast reactions.
Standard didactic instruction may provide insufficient training and reinforcement of acute contrast reaction management skills. Medical simulation may provide a valuable means of assessing residents' skills and comfort levels in managing severe contrast reactions.
本研究的目的是将医学模拟作为一种评估工具，以评价放射科住院医师对造影剂反应治疗方案的依从性，并了解他们对模拟体验的看法。
设计了一项针对二年级和三年级放射科住院医师对模拟的危及生命的造影剂反应管理的前瞻性观察性研究。在对科室造影剂反应方案进行标准的理论教学后，住院医师分别参与急性造影剂反应的高保真医学模拟。记录住院医师执行预定关键操作的情况。模拟前和模拟后的多项选择题测试评估住院医师对科室方案的了解程度。每位住院医师完成5分制的李克特式调查，评估在处理造影剂反应时的舒适度以及对模拟体验的看法。
住院医师平均执行了20项关键操作中的13项（范围为10 - 16项）。模拟前多项选择题测试的平均分数为56%，而模拟后的平均分数为92%（P = .0003）。研究干预前后，受试者对处理院内造影剂反应舒适度的平均评分分别为3.47和4.07（P = .03）。门诊环境下舒适度的平均评分在研究前为3.08，研究后为3.69（P = .69）。所有住院医师都强烈同意模拟是一次有价值的教育经历，而85%的住院医师强烈同意模拟提高了他们处理急性造影剂反应的技能。
标准的理论教学可能无法提供足够的急性造影剂反应管理技能培训和强化。医学模拟可能是评估住院医师处理严重造影剂反应技能和舒适度的一种有价值的手段。
