Pascual Jose L, Holena Daniel N, Vella Michael A, Palmieri Joseph, Sicoutris Corinna, Selvan Ben, Fox Adam D, Sarani Babak, Sims Carrie, Williams Noel N, Schwab Charles William
Division of Traumatology, Surgical Critical Care & Emergency Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
J Trauma. 2011 Aug;71(2):330-7; discussion 337-8. doi: 10.1097/TA.0b013e31821f4721.
Several studies evaluating simulation training in intensive care unit (ICU) physicians have demonstrated improvement in leadership and management skills. No study to date has evaluated whether such training is useful in established ICU advanced practitioners (APs). We hypothesized that human patient simulator-based training would improve surgical ICU APs' skills at managing medical crises.
After institutional review board approval, 12 APs completed ½ day of simulation training on the SimMan, Laerdal system. Each subject participated in five scenarios, first as team leader (pretraining scenario), then as observer for three scenarios, and finally, again as team leader (posttraining). Faculty teaching accompanied each scenario and preceded a debriefing session with video replay. Three experts scored emergency care skills (Airway-Breathing-Circulation [ABCs] sequence, recognition of shock, pneumothorax, etc.) and teamwork leadership/interpersonal skills. A multiple choice question examination and training effectiveness questionnaire were completed before and after training. Fellows underwent the same curriculum and served to validate the study. Pre- and postscores were compared using the Wilcoxon signed rank test with two-tailed significance of 0.05.
Improvement was seen in participants' scores combining all parameters (73% ± 13% vs. 80% ± 11%, p = 0.018). AP leadership/interpersonal skills (+12%), multiple choice question examination (+4%), and training effectiveness questionnaire (+6%) scores improved significantly (p < 0.05). Fellows teamwork leadership/interpersonal skills scores were higher than APs (p < 0.001) but training brought AP scores to fellow levels. Interrater reliability was high (r = 0.77, 95% confidence interval 0.71-0.82; p < 0.001).
Human patient simulator training in established surgical ICU APs improves leadership, teamwork, and self-confidence skills in managing medical emergencies. Such a validated curriculum may be useful as an AP continuing education resource.
多项评估重症监护病房（ICU）医生模拟培训的研究表明，他们的领导和管理技能有所提高。迄今为止，尚无研究评估此类培训对已成熟的ICU高级从业者（AP）是否有用。我们假设基于人体患者模拟器的培训将提高外科ICU高级从业者处理医疗危机的技能。
经机构审查委员会批准后，12名高级从业者在Laerdal公司的SimMan系统上完成了半天的模拟培训。每位受试者参与五个模拟场景，首先作为团队领导者（培训前场景），然后作为三个场景的观察者，最后再次作为团队领导者（培训后）。每个场景都有教员指导，并在视频回放的汇报环节之前进行。三位专家对急救技能（气道-呼吸-循环[ABC]顺序、休克识别、气胸等）以及团队合作领导/人际技能进行评分。培训前后完成一份多项选择题考试和培训效果问卷。研究员接受相同的课程培训，并用于验证该研究。使用Wilcoxon符号秩检验比较前后得分，双侧显著性为0.05。
综合所有参数，参与者的得分有所提高（73%±13%对80%±11%，p = 0.018）。高级从业者的领导/人际技能（提高12%）、多项选择题考试成绩（提高4%）和培训效果问卷得分（提高6%）显著提高（p < 0.05）。研究员的团队合作领导/人际技能得分高于高级从业者（p < 0.001），但培训使高级从业者的得分达到了研究员的水平。评分者间信度较高（r = 0.77，95%置信区间0.71 - 0.82；p < 0.001）。
对已成熟的外科ICU高级从业者进行人体患者模拟器培训可提高其在处理医疗紧急情况时的领导能力、团队合作能力和自信心。这样一个经过验证的课程可能作为高级从业者继续教育资源有用。
