Barsuk Jeffrey H, Cohen Elaine R, Vozenilek John A, O'Connor Lanty M, McGaghie William C, Wayne Diane B
J Grad Med Educ. 2012 Mar;4(1):23-7. doi: 10.4300/JGME-D-11-00161.1.
Paracentesis is a commonly performed bedside procedure that has the potential for serious complications. Therefore, simulation-based education for paracentesis is valuable for clinicians.
To assess internal medicine residents' procedural skills before and after simulation-based mastery learning on a paracentesis simulator.
A team with expertise in simulation and procedural skills developed and created a high fidelity, ultrasound-compatible paracentesis simulator. Fifty-eight first-year internal medicine residents completed a mastery learning-based intervention using the paracentesis simulator. Residents underwent baseline skill assessment (pretest) using a 25-item checklist. Residents completed a posttest after a 3-hour education session featuring a demonstration of the procedure, deliberate practice, ultrasound training, and feedback. All residents were expected to meet or exceed a minimum passing score (MPS) at posttest, the key feature of mastery learning. We compared pretest and posttest checklist scores to evaluate the effect of the educational intervention. Residents rated the training sessions.
Residents' paracentesis skills improved from an average pretest score of 33.0% (SD = 15.2%) to 92.7% (SD = 5.4%) at posttest (P < .001). After the training intervention, all residents met or exceeded the MPS. The training sessions and realism of the simulation were rated highly by learners.
This study demonstrates the ability of a paracentesis simulator to significantly improve procedural competence.
腹腔穿刺术是一种常见的床旁操作，有发生严重并发症的风险。因此，针对腹腔穿刺术的模拟培训对临床医生很有价值。
评估内科住院医师在腹腔穿刺模拟器上进行基于模拟的掌握学习前后的操作技能。
一个具备模拟和操作技能专业知识的团队开发并制作了一个高保真、兼容超声的腹腔穿刺模拟器。58名内科一年级住院医师使用该腹腔穿刺模拟器完成了基于掌握学习的干预。住院医师使用一份包含25个条目的清单进行基线技能评估（预测试）。在经过一场时长3小时的教育课程后，住院医师进行了后测，该课程包括操作演示、刻意练习、超声培训及反馈。掌握学习的关键特征是所有住院医师在后测中都要达到或超过最低及格分数（MPS）。我们比较了预测试和后测试的清单分数，以评估教育干预的效果。住院医师对培训课程进行了评分。
住院医师的腹腔穿刺技能从预测试的平均分数33.0%（标准差=15.2%）提高到后测的92.7%（标准差=5.4%）（P<.001）。经过培训干预后，所有住院医师都达到或超过了最低及格分数。学习者对培训课程和模拟的逼真度评价很高。
本研究证明了腹腔穿刺模拟器能显著提高操作能力。
