Langhan Trevor S, Rigby Ian J, Walker Ian W, Howes Daniel, Donnon Tyrone, Lord Jason A
Division of Emergency Medicine, University of Calgary, Calgary, Alberta, Canada.
CJEM. 2009 Nov;11(6):535-9. doi: 10.1017/s1481803500011805.
Residents must become proficient in a variety of procedures. The practice of learning procedural skills on patients has come under ethical scrutiny, giving rise to the concept of simulation-based medical education. Resident training in a simulated environment allows skill acquisition without compromising patient safety. We assessed the impact of a simulation-based procedural skills training course on residents' competence in the performance of critical resuscitation procedures.
We solicited self-assessments of the knowledge and clinical skills required to perform resuscitation procedures from a cross-sectional multidisciplinary sample of 28 resident study participants. Participants were then exposed to an intensive 8-hour simulation-based training program, and asked to repeat the self-assessment questionnaires on completion of the course, and again 3 months later. We assessed the validity of the self-assessment questionnaire by evaluating participants' skills acquisition through an Objective Structured Clinical Examination station.
We found statistically significant improvements in participants' ratings of both knowledge and clinical skills during the 3 self-assessment periods ( p < 0.001). The participants' year of postgraduate training influenced their self assessment of knowledge ( F = 4.91, p< 0.01) and clinical 2,25 skills ( F = 10.89, p< 0.001). At the 3-month follow-up, junior 2,25 level residents showed consistent improvement from their baseline scores, but had regressed from their posttraining measures. Senior-level residents continued to show further increases in their assessments of both clinical skills and knowledge beyond the simulation-based training course.
Significant improvement in self-assessed theoretical knowledge and procedural skill competence for residents can be achieved through participation in a simulation-based resuscitation course. Gains in perceived competence appear to be stable over time, with senior learners gaining further confidence at the 3-month follow-up. Our findings support the benefits of simulation-based training for residents.
住院医师必须熟练掌握各种操作程序。在患者身上学习操作技能的做法已受到伦理审查，由此产生了基于模拟的医学教育概念。在模拟环境中进行住院医师培训可在不危及患者安全的情况下获得技能。我们评估了基于模拟的操作技能培训课程对住院医师进行关键复苏程序操作能力的影响。
我们从28名住院医师研究参与者的多学科横断面样本中征集了对进行复苏程序所需知识和临床技能的自我评估。参与者随后接受了为期8小时的强化模拟培训计划，并在课程结束时以及3个月后再次被要求填写自我评估问卷。我们通过客观结构化临床考试站评估参与者的技能获取情况，以此评估自我评估问卷的有效性。
我们发现，在三个自我评估阶段，参与者在知识和临床技能评分上均有统计学意义的显著提高（p < 0.001）。参与者的研究生培训年份影响了他们对知识的自我评估（F = 4.91，p < 0.01）和临床技能的自我评估（F = 10.89，p < 0.001）。在3个月的随访中，初级水平的住院医师从基线分数开始持续改善，但与培训后的测量结果相比有所退步。高级水平的住院医师在基于模拟的培训课程之后，对临床技能和知识的评估继续显示出进一步提高。
通过参加基于模拟的复苏课程，住院医师在自我评估的理论知识和操作技能能力方面可取得显著进步。随着时间推移，感知到的能力提升似乎是稳定的，高级学习者在3个月随访时获得了更大的信心。我们的研究结果支持了基于模拟的培训对住院医师的益处。
