急性冠状动脉综合征与心脏骤停：运用模拟技术评估住院医师的表现及项目成果。

Acute coronary syndrome and cardiac arrest: using simulation to assess resident performance and program outcomes.

作者信息

Opar Susan P, Short Matthew W, Jorgensen Jennifer E, Blankenship Robert B, Roth Bernard J

出版信息

J Grad Med Educ. 2010 Sep;2(3):404-9. doi: 10.4300/JGME-D-10-00020.1.

DOI:10.4300/JGME-D-10-00020.1

PMID:21976090

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2951781/

Abstract

BACKGROUND

Simulation training has emerged as an effective method of educating residents in cardiac emergencies. Few studies have used emergency simulation scenarios as an outcome measure to identify training deficiencies within residency programs.

PURPOSE

The purpose of this study was to evaluate postgraduate year-1 (PGY-1) residents on their ability to manage an acute coronary syndrome and cardiac arrest scenario before and after internship in order to provide outcome data to improve program performance.

METHODS

A total of 58 PGY-1 residents from 10 medical specialties were evaluated using a human patient simulator before and after internship. They were given 12 minutes to manage a patient with acute coronary syndrome and ventricular fibrillation due to hyperkalemia. An objective checklist following basic and advanced cardiac life support guidelines was used to assess performance.

RESULTS

A total of 58 interns (age, 25 to 44 years [mean, 29.1]; 38 [65.6%] men; 41 [70.7%] allopathic medical school graduates) participated in both the incoming and outgoing examination. Overall chest pain scores increased from a mean of 60.0% to 76.1% (P < .01). Medical knowledge performance improved from 51.1% to 76.1% (P < .01). Systems-based practice performance improved from 40.9% to 71.0% (P < .01). However, patient care performance declined from 93.4% to 80.2% (P < .01).

CONCLUSIONS

A simulated acute coronary syndrome and cardiac arrest scenario can evaluate incoming PGY-1 competency performance and test for interval improvement. This assessment tool can measure resident competency performance and evaluate program effectiveness.

摘要

背景

模拟训练已成为培训住院医师应对心脏急症的有效方法。很少有研究将应急模拟场景作为一种结果指标，以识别住院医师培训项目中的培训缺陷。

目的

本研究旨在评估一年级住院医师（PGY-1）在实习前后处理急性冠状动脉综合征和心脏骤停场景的能力，以便提供结果数据来改善培训项目的表现。

方法

来自10个医学专业的58名PGY-1住院医师在实习前后使用人体患者模拟器进行评估。他们有12分钟时间来处理一名因高钾血症导致急性冠状动脉综合征和心室颤动的患者。使用遵循基础和高级心脏生命支持指南的客观检查表来评估表现。

结果

共有58名实习生（年龄25至44岁[平均29.1岁]；38名[65.6%]为男性；41名[70.7%]为全科医学院毕业生）参加了入学和结业考试。总体胸痛评分从平均60.0%提高到76.1%（P <.01）。医学知识表现从51.1%提高到76.1%（P <.01）。基于系统的实践表现从40.9%提高到71.0%（P <.01）。然而，患者护理表现从93.4%下降到80.2%（P <.01）。