高仿真模拟评估的紧急医疗服务领域表现与执业护理人员认知知识之间的关联。

The association between emergency medical services field performance assessed by high-fidelity simulation and the cognitive knowledge of practicing paramedics.

机构信息

The Center for Prehospital Medicine and Mecklenburg EMS Agency, Charlotte, NC, USA.

出版信息

Acad Emerg Med. 2011 Nov;18(11):1177-85. doi: 10.1111/j.1553-2712.2011.01208.x.

DOI:10.1111/j.1553-2712.2011.01208.x

PMID:22092899

Abstract

OBJECTIVES

The objective of this study was to assess the association between the performance of practicing paramedics on a validated cognitive exam and their field performance, assessed on a simulated emergency medical services (EMS) response.

METHODS

This was an observational study of paramedics from a single-tiered, urban, advanced life support EMS agency. A high-fidelity simulated response to a medical emergency on environmentally realistic sound stages, and the cognitive portion of the national paramedic certification exam, were each assessed as pass or fail. Participants were randomly assigned to one of six simulations designed by the agency's educational staff, medical director, and representatives from the National Registry of EMTs to be equivalently difficult. Simulations were pilot tested to assess content and face validity. Each participant was classified as failing a simulation scenario if his or her score was one standard deviation (SD) below the population mean.

RESULTS

There were 107 paramedics who participated in the study. Participants reported a median of 7.7 years of service (interquartile range [IQR] = 4.1 to 12.8 years). Simulation scores were normally distributed. Ninety-two (86.0%) participants received a passing score for the simulation and 77 (72.0%) passed the cognitive exam. There were 70 (65.4%) individuals who passed both the simulation and the cognitive exam, eight (7.5%) who failed both the simulation and the cognitive exam, 22 (20.6%) who passed the simulation but failed the cognitive exam, and seven (6.5%) who failed the simulation but passed the cognitive exam. There was a significant association between passing the cognitive exam and passing the simulation (chi-square p-value = 0.02).

CONCLUSIONS

This study simultaneously assessed cognitive knowledge and simulated field performance. Utilization of these measurement techniques allowed for the assessment and comparison of field performance and cognitive knowledge. Results demonstrated an association between a practicing paramedic's performance on a cognitive examination and field performance, assessed by a simulated EMS response.

摘要

目的

本研究旨在评估执业护理人员在经过验证的认知考试中的表现与他们在模拟紧急医疗服务（EMS）响应中的现场表现之间的关联。

方法

这是一项对来自单一层次、城市、高级生命支持 EMS 机构的护理人员进行的观察性研究。通过在环境逼真的音响舞台上进行高保真模拟医疗紧急情况响应，以及国家护理人员认证考试的认知部分，分别评估为通过或失败。参与者被随机分配到由该机构的教育人员、医疗主任和国家 EMT 注册代表设计的六个模拟场景之一，这些模拟场景被设计为难度相等。对模拟场景进行了试点测试，以评估内容和表面效度。如果参与者的分数比人群平均值低一个标准差（SD），则将其归类为模拟场景失败。

结果

共有 107 名护理人员参加了这项研究。参与者报告的服务中位数为 7.7 年（四分位距[IQR] = 4.1 至 12.8 年）。模拟得分呈正态分布。92（86.0%）名参与者的模拟得分通过，77（72.0%）名参与者的认知考试通过。有 70（65.4%）名参与者同时通过了模拟和认知考试，8（7.5%）名参与者同时未能通过模拟和认知考试，22（20.6%）名参与者通过了模拟但未能通过认知考试，以及 7（6.5%）名参与者未能通过模拟但通过了认知考试。认知考试通过与模拟通过之间存在显著关联（卡方 p 值 = 0.02）。