Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, CT, USA.
Prehosp Disaster Med. 2012 Jun;27(3):239-44. doi: 10.1017/S1049023X12000775. Epub 2012 Jun 13.
Pediatric disaster medicine (PDM) triage is a vital skill set for pediatricians, and is a required component of residency training by the Accreditation Council for Graduate Medical Education (ACGME). Simulation training is an effective tool for preparing providers for high-stakes, low-frequency events. Debriefing is a learner-centered approach that affords reflection on one's performance, and increases the efficacy of simulation training. The purpose of this study was to measure the efficacy of a multiple-victim simulation in facilitating learners' acquisition of pediatric disaster medicine (PDM) skills, including the JumpSTART triage algorithm. It was hypothesized that multiple patient simulations and a structured debriefing would improve triage performance.
A 10-victim school-shooting scenario was created. Victims were portrayed by adult volunteers, and by high- and low-fidelity simulation manikins that responded physiologically to airway maneuvers. Learners were pediatrics residents. Expected triage levels were not revealed. After a didactic session, learners completed the first simulation. Learners assigned triage levels to all victims, and recorded responses on a standardized form. A group structured debriefing followed the first simulation. The debriefing allowed learners to review the victims and discuss triage rationale. A new 10-victim trauma disaster scenario was presented one week later, and a third scenario was presented five months later. During the second and third scenarios, learners again assigned triage levels to multiple victims. Wilcoxon sign rank tests were used to compare pre- and post-test scores and performance on pre- and post-debriefing simulations.
A total of 53 learners completed the educational intervention. Initial mean triage performance was 6.9/10 patients accurately triaged (range = 5-10, SD = 1.3); one week after the structured debriefing, the mean triage performance improved to 8.0/10 patients (range = 5-10, SD = 1.37, P < .0001); five months later, there was maintenance of triage improvement, with a mean triage score of 7.8/10 patients (SD = 1.33, P < .0001). Over-triage of an uninjured child with special health care needs (CSHCN) (67.8% of learners prior to debriefing, 49.0% one week post-debriefing, 26.2% five months post-debriefing) and under-triage of head-injured, unresponsive patients (41.2% of learners pre-debriefing, 37.5% post-debriefing, 11.0% five months post-debriefing) were the most common errors.
Structured debriefings are a key component of PDM simulation education, and resulted in improved triage accuracy; the improvement was maintained five months after the educational intervention. Future curricula should emphasize assessment of CSHCN and head-injured patients.
儿科灾难医学（PDM）分诊是儿科医生的一项重要技能，也是研究生医学教育认证委员会（ACGME）对住院医师培训的要求。模拟培训是为高风险、低频率事件准备提供者的有效工具。讨论是一种以学习者为中心的方法，使学习者能够反思自己的表现，并提高模拟培训的效果。本研究的目的是衡量多例模拟在促进学习者获得儿科灾难医学（PDM）技能方面的效果，包括 JumpSTART 分诊算法。假设多个患者模拟和结构化讨论将提高分诊表现。
创建了一个 10 名受害者的学校枪击场景。受害者由成年志愿者和对气道操作有生理反应的高保真和低保真模拟假人扮演。学习者是儿科住院医师。预期分诊级别没有透露。在一个讲座课程之后，学习者完成了第一个模拟。学习者为所有受害者分配分诊级别，并在标准化表格上记录响应。第一个模拟之后进行了小组结构化讨论。讨论使学习者能够回顾受害者并讨论分诊原理。一周后呈现了一个新的 10 名受害者创伤灾难场景，五个月后呈现了第三个场景。在第二和第三个场景中，学习者再次为多个受害者分配分诊级别。使用 Wilcoxon 符号秩检验比较预测试和后测试分数以及预讨论和后讨论模拟的表现。
共有 53 名学习者完成了教育干预。最初的平均分诊表现为 6.9/10 名患者分诊准确（范围=5-10，SD=1.3）；在结构化讨论后的一周，平均分诊表现提高到 8.0/10 名患者（范围=5-10，SD=1.37，P<.0001）；五个月后，分诊改善得到维持，平均分诊得分为 7.8/10 名患者（SD=1.33，P<.0001）。对一名有特殊医疗需求的未受伤儿童（CSHCN）过度分诊（讨论前 67.8%的学习者，讨论后一周 49.0%，讨论后五个月 26.2%）和对头部受伤、无反应的患者分诊不足（讨论前 41.2%的学习者，讨论后一周 37.5%，讨论后五个月 11.0%）是最常见的错误。
结构化讨论是 PDM 模拟教育的关键组成部分，可提高分诊准确性；干预五个月后仍保持改善。未来的课程应强调对 CSHCN 和头部受伤患者的评估。
