Strachan Alasdair N, Graham Alastair C, Hormis Anil P, Hilton Gill
Montagu Clinical Simulation Centre, Montagu Hospital, Mexborough, UK.
Educ Prim Care. 2011 Jul;22(4):229-34. doi: 10.1080/14739879.2011.11494005.
Medical emergencies in general practice are uncommon and their management requires good teamwork, communication and effective use of the available resources by the whole primary care team. To address this need the Montagu Clinical Simulation Centre developed and delivered a half-day simulation-based medical emergencies course for primary care teams (GPs, practice nurses and administrative staff). Each half-day course comprises two simulated medical emergencies, which are video-taped and then debriefed. The course was evaluated using a multi-level approach by seeking the staff's reactions to the course, their learning, the behaviour changes produced and the results for the organisation. We gained this information through self-reporting using end-of-course and follow-up questionnaires. The immediate feedback was very positive, showing they had learnt the objectives set. We then surveyed all those who had attended training between 2003 and 2007. A follow-up questionnaire was developed and sent to the practice managers who then co-ordinated their completion and return using a pre-paid return envelope. The survey was carried out in two cohorts. The first set of follow-up questionnaires was sent out in September 2004 to all those that had attended up to the end of May 2004 and the second set sent out in May 2008 to those who had attended between June 2004 and May 2007. Of the 338 available to complete the follow-up questionnaire, 208 responded, giving a response rate of 62%. Eighty percent of practices had made changes to equipment, emergency protocols or training and 20% of the participants had been involved in managing a medical emergency since attending the course. Of those, 86% indicated that their management and confidence had improved, that they were better able to take a lead role, give instruction and delegate tasks as required. Based on the self-reported perceptions of learning, we believe that the lessons learnt have been translated into positive changes at a personal and practice level for all members of the primary care team. The participants valued the chance to train as a complete unit. We plan to evaluate simulation-based training in the workplace to see if this has a greater impact.
全科医疗中的医疗紧急情况并不常见，其处理需要整个基层医疗团队具备良好的团队合作、沟通能力，并能有效利用现有资源。为满足这一需求，蒙塔古临床模拟中心为基层医疗团队（全科医生、执业护士和行政人员）开发并提供了一个为期半天的基于模拟的医疗紧急情况课程。每个半天的课程包括两个模拟医疗紧急情况，课程会进行录像，然后进行总结汇报。通过寻求工作人员对课程的反应、他们的学习情况、产生的行为变化以及对组织的影响，采用多层次方法对该课程进行了评估。我们通过课程结束时和后续问卷调查的自我报告来获取这些信息。即时反馈非常积极，表明他们学到了设定的目标。然后，我们对2003年至2007年间参加培训的所有人进行了调查。我们设计了一份后续问卷，并发送给各诊所经理，由他们协调问卷的填写并使用预付回邮信封寄回。调查分两个队列进行。第一组后续问卷于2004年9月发送给截至2004年5月底参加培训的所有人，第二组于2008年5月发送给2004年6月至2007年5月期间参加培训的人。在338份可供填写后续问卷的人中，有208人回复，回复率为62%。80%的诊所对设备、应急方案或培训进行了更改，20%的参与者自参加课程以来参与过医疗紧急情况的处理。其中，86%的人表示他们的处理能力和信心有所提高，能够更好地发挥主导作用、按要求进行指导和分配任务。基于自我报告的学习认知，我们认为所学经验已转化为基层医疗团队所有成员在个人和诊所层面的积极变化。参与者重视作为一个完整团队进行培训的机会。我们计划评估工作场所基于模拟的培训，看其是否有更大影响。
