Division of Emergency Medicine, Children's Hospital of Philadelphia, Pennsylvania 19104, USA.
Simul Healthc. 2010 Feb;5(1):16-20. doi: 10.1097/SIH.0b013e3181a46aa1.
Physical signs that can be seen, heard, and felt are one of the cardinal features that convey realism in patient simulations. In critically ill children, physical signs are relied on for clinical management despite their subjective nature. Current technology is limited in its ability to effectively simulate some of these subjective signs; at the same time, data supporting the educational benefit of simulated physical features as a distinct entity are lacking. We surveyed pediatric housestaff as to the realism of scenarios with and without simulated physical signs.
Residents at three children's hospitals underwent a before-and-after assessment of performance in mock resuscitations requiring Pediatric Advanced Life Support (PALS), with a didactic review of PALS as the intervention between the assessments. Each subject was randomized to a simulator with physical features either activated (simulator group) or deactivated (mannequin group). Subjects were surveyed as to the realism of the scenarios. Univariate analysis of responses was done between groups. Subjects in the high-fidelity group were surveyed as to the relative importance of specific physical features in enhancing realism.
Fifty-one subjects completed all surveys. Subjects in the high-fidelity group rated all scenarios more highly than low-fidelity subjects; the difference achieved statistical significance in scenarios featuring a patient in asystole or pulseless ventricular tachycardia (P < 0.04 for both comparisons). Chest wall motion and palpable pulses were rated most highly among physical features in contributing to realism.
PALS scenarios were rated as highly realistic by pediatric residents. Slight differences existed between subjects exposed to simulated physical features and those not exposed to them; these differences were most pronounced in scenarios involving pulselessness. Specific physical features were rated as more important than others by subjects. Data from these surveys may be informative in designing future simulation technology.
可见、可听和可触的体征是模拟患者时体现真实性的重要特征之一。在危重症患儿中，尽管这些体征是主观的，但仍依赖于这些体征进行临床管理。当前的技术在有效模拟某些主观体征方面能力有限；同时，缺乏支持模拟物理特征作为一个独特实体的教育益处的数据。我们调查了儿科住院医师对有和没有模拟物理体征的场景的逼真程度的看法。
三家儿童医院的住院医师接受了模拟复苏的前后评估，需要进行儿科高级生命支持（PALS），干预措施是在两次评估之间进行 PALS 的教学复习。每个受试者都被随机分配到一个带有或不带有物理特征的模拟器（模拟器组或模型组）。受试者被调查了场景的逼真程度。对组间的反应进行了单变量分析。在高保真组中，对特定物理特征在增强现实感方面的相对重要性进行了调查。
51 名受试者完成了所有调查。高保真组的受试者比低保真组的受试者对所有场景的评价更高；在涉及心搏停止或无脉性室性心动过速的场景中，差异达到了统计学意义（两种比较均 P <0.04）。胸壁运动和可触及的脉搏在增强真实感方面的评分最高。
儿科住院医师认为 PALS 场景具有高度的真实性。暴露于模拟物理特征和未暴露于模拟物理特征的受试者之间存在细微差异；在涉及无脉性的场景中，这些差异最为明显。受试者认为某些物理特征比其他特征更为重要。这些调查数据可能有助于设计未来的模拟技术。
