University of Toronto, Toronto, Canada.
Pain Res Manag. 2011 Nov-Dec;16(6):433-9. doi: 10.1155/2011/278397.
BACKGROUND⁄
Pain-related misbeliefs among health care professionals (HCPs) are common and contribute to ineffective postoperative pain assessment. While standardized patients (SPs) have been effectively used to improve HCPs' assessment skills, not all centres have SP programs. The present equivalence randomized controlled pilot trial examined the efficacy of an alternative simulation method - deteriorating patient-based simulation (DPS) - versus SPs for improving HCPs' pain knowledge and assessment skills.
Seventy-two HCPs were randomly assigned to a 3 h SP or DPS simulation intervention. Measures were recorded at baseline, immediate postintervention and two months postintervention. The primary outcome was HCPs' pain assessment performance as measured by the postoperative Pain Assessment Skills Tool (PAST). Secondary outcomes included HCPs knowledge of pain-related misbeliefs, and perceived satisfaction and quality of the simulation. These outcomes were measured by the Pain Beliefs Scale (PBS), the Satisfaction with Simulated Learning Scale (SSLS) and the Simulation Design Scale (SDS), respectively. Student's t tests were used to test for overall group differences in postintervention PAST, SSLS and SDS scores. One-way analysis of covariance tested for overall group differences in PBS scores.
DPS and SP groups did not differ on post-test PAST, SSLS or SDS scores. Knowledge of pain-related misbeliefs was also similar between groups.
These pilot data suggest that DPS is an effective simulation alternative for HCPs' education on postoperative pain assessment, with improvements in performance and knowledge comparable with SP-based simulation. An equivalence trial to examine the effectiveness of deteriorating patient-based simulation versus standardized patients is warranted.
医护人员（HCPs）存在常见的与疼痛相关的误解，这会导致术后疼痛评估不准确。虽然标准化患者（SPs）已被有效地用于提高 HCPs 的评估技能，但并非所有中心都有 SP 项目。本等效随机对照试验研究了替代模拟方法——恶化患者模拟（DPS）与 SPs 对提高 HCPs 疼痛知识和评估技能的效果。
72 名 HCPs 被随机分配到 3 小时的 SP 或 DPS 模拟干预组。在基线、即时干预后和干预后两个月记录测量值。主要结局是通过术后疼痛评估技能工具（PAST）测量 HCPs 的疼痛评估表现。次要结局包括 HCPs 对疼痛相关误解的知识，以及对模拟的满意度和质量。这些结果分别通过疼痛信念量表（PBS）、模拟学习满意度量表（SSLS）和模拟设计量表（SDS）进行测量。采用学生 t 检验测试干预后 PAST、SSLS 和 SDS 得分的总体组间差异。单因素方差分析测试 PBS 得分的总体组间差异。
DPS 和 SP 组在测试后 PAST、SSLS 或 SDS 得分上没有差异。两组对疼痛相关误解的知识也相似。
这些初步数据表明，DPS 是 HCPs 术后疼痛评估教育的有效替代模拟方法，在提高表现和知识方面与基于 SP 的模拟相当。需要进行一项等效试验来检验恶化患者模拟与标准化患者的有效性。
