Bretholz Adam, Doan Quynh, Cheng Adam, Lauder Gillian
Montreal Children's Hospital, Montreal, Quebec, Canada.
Pediatr Emerg Care. 2012 Jun;28(6):506-9. doi: 10.1097/PEC.0b013e3182586f42.
Fracture pain in the pediatric emergency department generally is treated with systemic analgesia using opioids. Fracture pain can alternatively be controlled with ultrasound (U/S)-guided nerve blocks for which only minimal training is available to pediatric emergency medicine physicians. This study evaluated the effects of a Web- and half-day simulation-based U/S course. Outcome measures were physician comfort level with and intention to use U/S-guided nerve blocks in clinical practice.
We conducted a presurvey and postsurvey study targeting pediatric emergency medicine physicians. Participants completed a Web-based tutorial and a half-day simulation program. Participants completed survey questionnaires to document their comfort level and intention to use U/S-guided nerve blocks. Questionnaires were completed before, immediately after, and 1 month after course.
Eleven physicians participated in the study. The participants' comfort with and intention to use U/S-guided ulnar and femoral nerve blocks increased immediately after course, but neither increase was sustained 1 month after course. Immediately following the course, participants reported that the course addressed their learning needs (91%) and that they would consider advanced training (91%). One month after course, participants reported that they would partake in refresher courses (82%), particularly if offered once per year (64%).
This study suggests that Web- and simulation-based learning can increase comfort and intention to use U/S-guided nerve blocks and the need for follow-on training. Participants reported that their learning needs were met but that they would need annual refresher courses.
儿科急诊科的骨折疼痛通常采用阿片类药物进行全身镇痛治疗。骨折疼痛也可以通过超声（U/S）引导的神经阻滞来控制，而儿科急诊医学医生接受的此类培训极少。本研究评估了基于网络和半天模拟的超声课程的效果。结果指标为医生在临床实践中对超声引导神经阻滞的舒适度和使用意愿。
我们针对儿科急诊医学医生开展了一项课前调查和课后调查研究。参与者完成了一个基于网络的教程和一个半天的模拟项目。参与者完成调查问卷，以记录他们对超声引导神经阻滞的舒适度和使用意愿。问卷在课程开始前、课程结束后立即以及课程结束后1个月完成。
11名医生参与了该研究。参与者对超声引导尺神经和股神经阻滞的舒适度和使用意愿在课程结束后立即有所提高，但在课程结束1个月后均未持续。课程结束后，参与者报告称该课程满足了他们的学习需求（91%），并且他们会考虑接受进阶培训（91%）。课程结束1个月后，参与者报告称他们会参加复习课程（82%），特别是如果每年提供一次（64%）。
本研究表明，基于网络和模拟的学习可以提高对超声引导神经阻滞的舒适度和使用意愿以及对后续培训的需求。参与者报告称他们的学习需求得到了满足，但他们需要每年参加复习课程。
