一项比较严重脓毒症医学模拟课程中教学讲座与案例情景的多国随机研究。

A multinational randomised study comparing didactic lectures with case scenario in a severe sepsis medical simulation course.

机构信息

Department of Emergency Medicine, Chang-Gung Memorial Hospital, Keelung Branch, Keelung City, Taiwan.

出版信息

Emerg Med J. 2012 Jul;29(7):559-64. doi: 10.1136/emermed-2011-200068. Epub 2011 Jul 27.

DOI:10.1136/emermed-2011-200068

PMID:21795293

Abstract

BACKGROUND

Medical simulation has been used to teach critical illness in a variety of settings. This study examined the effect of didactic lectures compared with simulated case scenario in a medical simulation course on the early management of severe sepsis.

METHODS

A prospective multicentre randomised study was performed enrolling resident physicians in emergency medicine from four hospitals in Asia. Participants were randomly assigned to a course that included didactic lectures followed by a skills workshop and simulated case scenario (lecture-first) or to a course that included a skills workshop and simulated case scenario followed by didactic lectures (simulation-first). A pre-test was given to the participants at the beginning of the course, post-test 1 was given after the didactic lectures or simulated case scenario depending on the study group assignment, then a final post-test 2 was given at the end of the course. Performance on the simulated case scenario was evaluated with a performance task checklist.

RESULTS

98 participants were enrolled in the study. Post-test 2 scores were significantly higher than pre-test scores in all participants (80.8 ± 12.0% vs 65.4 ± 12.2%, p<0.01). There was no difference in pre-test scores between the two study groups. The lecture-first group had significantly higher post-test 1 scores than the simulation-first group (78.8 ± 10.6% vs 71.6 ± 12.6%, p<0.01). There was no difference in post-test 2 scores between the two groups. The simulated case scenario task performance completion was 90.8% (95% CI 86.6% to 95.0%) in the lecture-first group compared with 83.8% (95% CI 79.5% to 88.1%) in the simulation-first group (p=0.02).

CONCLUSIONS

A medical simulation course can improve resident physician knowledge in the early management of severe sepsis. Such a course should include a comprehensive curriculum that includes didactic lectures followed by simulation experience.

摘要

背景

医学模拟已被用于在各种环境中教授危重病学。本研究旨在探讨医学模拟课程中与模拟病例情景相比，理论授课与技能培训和模拟病例情景对严重脓毒症早期管理的影响。

方法

本前瞻性多中心随机研究纳入了来自亚洲四家医院的急诊住院医师。参与者被随机分配到一个课程，该课程包括理论授课，然后是技能培训和模拟病例情景（先授课），或一个课程，该课程包括技能培训和模拟病例情景，然后是理论授课（先模拟）。在课程开始时对参与者进行了预测试，根据研究组分配，在理论授课或模拟病例情景后进行了第一次测试，然后在课程结束时进行了最终的第二次测试。使用操作任务检查表评估模拟病例情景的表现。

结果

本研究共纳入了 98 名参与者。所有参与者的第二次后测得分均显著高于预测试得分（80.8 ± 12.0%对 65.4 ± 12.2%，p<0.01）。两组研究对象的预测试得分无差异。先授课组的第一次后测得分显著高于先模拟组（78.8 ± 10.6%对 71.6 ± 12.6%，p<0.01）。两组的第二次后测得分无差异。先授课组的模拟病例情景任务完成率为 90.8%（95%CI 86.6%至 95.0%），而先模拟组为 83.8%（95%CI 79.5%至 88.1%）（p=0.02）。