Department of Emergency Medicine, Chang-Gung Memorial Hospital, Keelung Branch, Keelung City, Taiwan.
Emerg Med J. 2012 Jul;29(7):559-64. doi: 10.1136/emermed-2011-200068. Epub 2011 Jul 27.
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.
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.
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).
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.
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。
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。
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）。
医学模拟课程可以提高住院医师对严重脓毒症早期管理的知识。这样的课程应该包括一个全面的课程，包括理论授课，然后是模拟经验。
