Department of Surgery, Washington University, Saint Louis, Missouri, USA.
J Surg Educ. 2012 May-Jun;69(3):428-31. doi: 10.1016/j.jsurg.2011.09.009. Epub 2011 Nov 3.
To demonstrate that instruction of proper team function can occur using high-fidelity simulated trauma resuscitation with video-assisted debriefing and that this process can be integrated rapidly into a standard general surgery curriculum.
The rater reliability of our team metric was assessed by having physicians and nonphysicians rate the same video-recorded trauma simulations at intervals in time. To assess the effectiveness of video debriefing, subjects participated in a 3-week trauma team training course that consisted of 2 video-recorded simulation sessions, each approximately 2 hours in length separated by a 90-minute debriefing session. To assess the impact of the debriefing session, video recordings of participants performing resuscitations before and after the debriefing were reviewed by a panel of blinded traumatologists and graded using our team evaluation instrument.
The study took place at the high-fidelity simulation center at a large, urban academic training hospital.
All 11 PGY-2 general surgery and combined general surgery and plastic surgery residents at our institution.
Our instrument was found to have high interrater correlation (interclass correlation coefficient [ICC], 0.926; 95% confidence interval, 0.893-0.953). Initially, residents were either unsure as to their competency to serve as team leader (70%) or felt they were not competent to serve as team leader (30%). Ninety percent of residents found the video debriefing very to extremely helpful in improving team function and clinical competency. All participants felt more competent as both team leaders and team members because of the video debriefing. The mean team function score improved significantly after video debriefing (4.39 [±0.3] vs 5.45 [±0.4] prevideo vs postvideo review, p < 0.05).
Video review with debriefing is an effective means of teaching team competencies and improving team function in simulated trauma resuscitation. This strategy can be integrated readily into the surgical curriculum analogous to other applications of simulation technology.
展示使用高保真模拟创伤复苏进行适当团队功能指导的方法，并证明该过程可以快速融入标准的普通外科课程中。
通过让医生和非医生在不同时间间隔对同一段视频记录的创伤模拟进行评分，评估我们团队指标的评分者间可靠性。为了评估视频讨论的效果，参与者参加了为期 3 周的创伤团队培训课程，该课程包括 2 次视频记录的模拟，每次大约 2 小时，中间间隔 90 分钟的讨论。为了评估讨论的效果，由一组盲法创伤学家审查参与者在讨论前后进行复苏的视频记录，并使用我们的团队评估工具进行评分。
这项研究在一家大型城市学术培训医院的高保真模拟中心进行。
我们机构的所有 11 名 PGY-2 普通外科住院医师和普通外科与整形外科联合住院医师。
我们的仪器被发现具有很高的评分者间相关性（组内相关系数 [ICC]，0.926；95%置信区间，0.893-0.953）。最初，住院医师要么不确定自己是否有能力担任团队领导（70%），要么觉得自己没有能力担任团队领导（30%）。90%的住院医师认为视频讨论非常有助于提高团队功能和临床能力。由于视频讨论，所有参与者都感到自己作为团队领导和团队成员的能力都有所提高。视频讨论后团队功能评分显著提高（4.39[±0.3]与视频讨论前（4.39[±0.3]）相比，p<0.05）。
视频回顾与讨论是教授团队能力和提高模拟创伤复苏中团队功能的有效方法。这种策略可以像模拟技术的其他应用一样，轻松融入外科课程。
