James A. Haley Veterans Administration, FL, USA.
J Clin Rheumatol. 2011 Apr;17(3):121-3. doi: 10.1097/RHU.0b013e318214bb54.
Arthrocentesis is an important skill for medical practitioners at all levels of training. Previous studies have indicated a low comfort level and performance of arthrocentesis among primary care physicians that could be improved with hands-on training.
The objective of this study was to improve comfort with knee and shoulder arthrocentesis at all levels of medical training, including medical students, internal medicine residents, and rheumatology subspecialty residents, and in arthrocentesis of the elbow, wrist, and ankle for advanced subspecialty residents in rheumatology through the use of a formal workshop using simulators.
Fourth-year medical students and internal medicine residents were recruited from the University of South Florida. The rheumatology advanced subspecialty residents were participants from University of South Florida and from the American College of Rheumatology national meetings in 2008 and 2009. A 1-hour PowerPoint lecture followed by a hands-on practice session using Sawbones models (shoulder and knee for all groups, and elbow, wrist, and ankle additionally for the advanced subspecialty residents). A preworkshop self-assessment survey allowed the participant to rate his/her comfort level with arthrocentesis on a scale of 1 to 5. A survey with identical questions was completed immediately after the workshop. A follow-up survey was distributed by e-mail 3 to 6 months after the workshop.
One hundred forty-one medical students, 75 internal medicine residents, and 39 rheumatology subspecialty residents participated from January 2008 until January 2010. Mean comfort level in knee and shoulder arthrocentesis improved from preworkshop comfort level for all joints and among all participants. In addition, rheumatology subspecialty resident mean comfort level improved for ankle from 2.37 to 3.65, elbow from 2.56 to 3.80, and wrist from 2.31 to 3.77 (P < 0.0001).
Our study involved a very large number of participants encompassing different levels of training and is the largest number of advanced subspecialty rheumatology residents studied with regard to joint injection training. We have confirmed that a formal joint injection workshop using simulators is an effective method of improving comfort level in arthrocentesis among participants from all levels of medical training. Future studies should evaluate the effect of such training on actual clinical use and competence.
关节穿刺术是各级培训的医学从业者的一项重要技能。先前的研究表明，初级保健医生在关节穿刺术方面的舒适度和表现较低，可以通过实践培训来提高。
本研究的目的是通过使用模拟器进行正式的关节穿刺术工作坊，提高各级医学培训（包括医学生、内科住院医师和风湿病学专业住院医师）以及高级专业风湿病学住院医师的肘部、腕部和踝部关节穿刺术的舒适度。
从南佛罗里达大学招募了四年级医学生和内科住院医师。风湿病学高级专业住院医师是来自南佛罗里达大学和 2008 年和 2009 年美国风湿病学会全国会议的参与者。进行了 1 小时的 PowerPoint 讲座，然后使用 Sawbones 模型（所有组的肩部和膝关节，以及高级专业住院医师的肘部、腕部和踝关节）进行了实际操作练习。在研讨会前的自我评估调查中，参与者可以在 1 到 5 的量表上对自己进行关节穿刺术的舒适度进行评分。研讨会后立即完成了一份具有相同问题的调查。在研讨会结束后 3 到 6 个月，通过电子邮件分发了一份后续调查。
从 2008 年 1 月到 2010 年 1 月，共有 141 名医学生、75 名内科住院医师和 39 名风湿病学专业住院医师参加了研究。所有关节和所有参与者的膝关节和肩关节穿刺术舒适度均较术前有所提高。此外，风湿病学专业住院医师的踝关节舒适度从 2.37 提高到 3.65，肘部从 2.56 提高到 3.80，腕部从 2.31 提高到 3.77（P < 0.0001）。
我们的研究涉及到不同培训水平的大量参与者，是关于关节注射培训的最大数量的高级专业风湿病学住院医师研究。我们已经证实，使用模拟器进行正式的关节注射工作坊是提高各级医学培训参与者关节穿刺术舒适度的有效方法。未来的研究应该评估这种培训对实际临床应用和能力的影响。
