Fehr James J, Honkanen Anita, Murray David J
Department of Anesthesiology and Pediatrics, Washington University School of Medicine, St Louis, MO 63110, USA.
Paediatr Anaesth. 2012 Oct;22(10):988-94. doi: 10.1111/pan.12001.
Simulation-based training, research and quality initiatives are expanding in pediatric anesthesiology just as in other medical specialties. Various modalities are available, from task trainers to standardized patients, and from computer-based simulations to mannequins. Computer-controlled mannequins can simulate pediatric vital signs with reasonable reliability; however the fidelity of skin temperature and color change, airway reflexes and breath and heart sounds remains rudimentary. Current pediatric mannequins are utilized in simulation centers, throughout hospitals in-situ, at national meetings for continuing medical education and in research into individual and team performance. Ongoing efforts by pediatric anesthesiologists dedicated to using simulation to improve patient care and educational delivery will result in further dissemination of this technology. Health care professionals who provide complex, subspecialty care to children require a curriculum supported by an active learning environment where skills directly relevant to pediatric care can be developed. The approach is not only the most effective method to educate adult learners, but meets calls for education reform and offers the potential to guide efforts toward evaluating competence. Simulation addresses patient safety imperatives by providing a method for trainees to develop skills and experience in various management strategies, without risk to the health and life of a child. A curriculum that provides pediatric anesthesiologists with the range of skills required in clinical practice settings must include a relatively broad range of task-training devises and electromechanical mannequins. Challenges remain in defining the best integration of this modality into training and clinical practice to meet the needs of pediatric patients.
基于模拟的培训、研究和质量改进举措在小儿麻醉领域正如在其他医学专科中一样不断扩展。有多种方式可供选择，从任务训练器到标准化病人，从基于计算机的模拟到人体模型。计算机控制的人体模型能够以合理的可靠性模拟小儿生命体征；然而，皮肤温度和颜色变化、气道反射以及呼吸和心音的逼真度仍很初级。当前的小儿人体模型被用于模拟中心、医院各科室现场、全国性继续医学教育会议以及个人和团队表现的研究中。小儿麻醉医生致力于利用模拟来改善患者护理和教育提供的持续努力将导致这项技术的进一步推广。为儿童提供复杂专科护理的医护人员需要一个由积极学习环境支持的课程体系，在这个环境中可以培养与小儿护理直接相关的技能。这种方法不仅是教育成年学习者的最有效方式，还满足了教育改革的要求，并为指导能力评估工作提供了潜力。模拟通过为受训人员提供一种在各种管理策略中培养技能和经验的方法，同时又不对儿童的健康和生命构成风险，从而满足了患者安全的要求。一个为小儿麻醉医生提供临床实践所需各种技能的课程体系必须包括范围相对广泛的任务训练装置和机电人体模型。在确定如何将这种方式最佳地整合到培训和临床实践中以满足小儿患者的需求方面，仍然存在挑战。
