Division of Pulmonary and Critical Care Medicine, Rochester, MN.
Division of General Internal Medicine, Mayo Clinic, Rochester, MN; Office of Education Research, Mayo Medical School, Mayo Foundation for Medical Education and Research, Rochester, MN.
Chest. 2013 Jul;144(1):183-192. doi: 10.1378/chest.12-1786.
Simulation-based bronchoscopy training is increasingly used, but effectiveness remains uncertain. We sought to perform a comprehensive synthesis of published work on simulation-based bronchoscopy training.
We searched MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Web of Science, and Scopus for eligible articles through May 11, 2011. We included all original studies involving health professionals that evaluated, in comparison with no intervention or an alternative instructional approach, simulation-based training for flexible or rigid bronchoscopy. Study selection and data abstraction were performed independently and in duplicate. We pooled results using random effects meta-analysis.
From an initial pool of 10,903 articles, we identified 17 studies evaluating simulation-based bronchoscopy training. In comparison with no intervention, simulation training was associated with large benefits on skills and behaviors (pooled effect size, 1.21 [95% CI, 0.82-1.60]; n=8 studies) and moderate benefits on time (0.62 [95% CI, 0.12-1.13]; n=7). In comparison with clinical instruction, behaviors with real patients showed nonsignificant effects favoring simulation for time (0.61 [95% CI, -1.47 to 2.69]) and process (0.33 [95% CI, -1.46 to 2.11]) outcomes (n=2 studies each), although variation in training time might account for these differences. Four studies compared alternate simulation-based training approaches. Inductive analysis to inform instructional design suggested that longer or more structured training is more effective, authentic clinical context adds value, and animal models and plastic part-task models may be superior to more costly virtual-reality simulators.
Simulation-based bronchoscopy training is effective in comparison with no intervention. Comparative effectiveness studies are few.
基于模拟的支气管镜检查培训越来越多地被使用，但效果仍不确定。我们试图对基于模拟的支气管镜检查培训的已发表文献进行全面综合。
我们通过 2011 年 5 月 11 日搜索了 MEDLINE、EMBASE、CINAHL、PsycINFO、ERIC、Web of Science 和 Scopus 中符合条件的文章。我们纳入了所有评估健康专业人员的基于模拟的柔性或刚性支气管镜检查培训的原始研究，这些研究与无干预或替代教学方法进行了比较。研究选择和数据提取由两人独立进行。我们使用随机效应荟萃分析汇总结果。
从最初的 10903 篇文章中，我们确定了 17 项评估基于模拟的支气管镜检查培训的研究。与无干预相比，模拟培训在技能和行为方面具有较大的益处（汇总效应量，1.21 [95%置信区间，0.82-1.60]；n=8 项研究），在时间方面具有中等益处（0.62 [95%置信区间，0.12-1.13]；n=7 项研究）。与临床教学相比，对真实患者的行为显示出无统计学意义的效果，支持模拟在时间（0.61 [95%置信区间，-1.47 至 2.69]）和过程（0.33 [95%置信区间，-1.46 至 2.11]）结果方面的优势（每项研究各有 2 项），尽管培训时间的差异可能导致这些差异。四项研究比较了替代的基于模拟的培训方法。归纳分析以提供教学设计信息表明，更长或更结构化的培训更有效，真实的临床环境增加了价值，动物模型和塑料部分任务模型可能优于更昂贵的虚拟现实模拟器。
与无干预相比，基于模拟的支气管镜检查培训是有效的。比较有效性研究很少。
