Department of Emergency Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
Acad Emerg Med. 2009 Dec;16 Suppl 2:S71-5. doi: 10.1111/j.1553-2712.2009.00590.x.
To assess the ability of a screen-based simulation-training program to improve emergency medicine and pediatric resident performance in critical pediatric resuscitation knowledge, confidence, and skills.
A pre-post, interventional design was used. Three measures of performance were created and assessed before and after intervention: a written pre-course knowledge examination, a self-efficacy confidence score, and a skills-based high-fidelity simulation code scenario. For the high-fidelity skills assessment, independent physician raters recorded and reviewed subject performance. The intervention consisted of eight screen-based pediatric resuscitation scenarios that subjects had 4 weeks to complete. Upon completion of the scenarios, all three measures were repeated. For the confidence assessment, summary pre- and post-test summary confidence scores were compared using a t-test, and for the skills assessment, pre-scores were compared with post-test measures for each individual using McNemar's chi-square test for paired samples.
Twenty-six of 35 (71.3%) enrolled subjects completed the institutional review board-approved study. Increases were observed in written test scores, confidence, and some critical interventions in high-fidelity simulation. The mean improvement in cumulative confidence scores for all residents was 10.1 (SD +/-4.9; range 0-19; p < 0.001), with no resident feeling less confident after the intervention. Although overall performance in simulated codes did not change significantly, with average scores of 6.65 (+/-1.76) to 7.04 (+/-1.37) out of 9 possible points (p = 0.58), improvement was seen in the administering of appropriate amounts of IV fluids (59-89%, p = 0.03).
In this study, improvements in resident knowledge, confidence, and performance of certain skills in simulated pediatric cardiac arrest scenarios suggest that screen-based simulations may be an effective way to enhance resuscitation skills of pediatric providers. These results should be confirmed using a randomized design with an appropriate control group.
评估基于屏幕的模拟培训计划在提高急诊医学和儿科住院医师在儿童危急复苏知识、信心和技能方面的能力。
采用前后干预的设计。在干预前后创建并评估了三种表现评估：书面课前知识考试、自我效能信心评分和基于技能的高保真模拟代码场景。对于高保真技能评估，独立医生评估者记录并审查了受试者的表现。干预措施包括 8 个基于屏幕的儿科复苏场景，受试者有 4 周时间完成。完成场景后，重复所有三个评估。对于信心评估，使用 t 检验比较了预测试和后测试的汇总信心评分，对于技能评估，使用 McNemar 的配对样本卡方检验比较了前测试分数与后测试的每个个体的分数。
在 35 名入组的受试者中，有 26 名（71.3%）完成了机构审查委员会批准的研究。书面测试成绩、信心和高保真模拟中的一些关键干预措施都有所提高。所有住院医师的累积信心评分平均提高了 10.1（SD +/-4.9；范围 0-19；p < 0.001），没有住院医师在干预后感到不那么自信。尽管模拟代码的总体表现没有显著变化，平均得分为 9 分中的 6.65（+/-1.76）至 7.04（+/-1.37）（p = 0.58），但在给予适当量的静脉输液方面有所改善（59-89%，p = 0.03）。
在这项研究中，住院医师在模拟儿童心搏骤停场景中的知识、信心和某些技能表现方面的提高表明，基于屏幕的模拟可能是增强儿科提供者复苏技能的有效方法。这些结果应使用随机设计和适当的对照组进行确认。
