*Division of Surgery, Department of Surgery and Cancer; and †Faculty of Medicine, Imperial College London, London, United Kingdom.
Ann Surg. 2014 Feb;259(2):215-21. doi: 10.1097/SLA.0b013e318288e1d4.
To assess the feasibility of developing a simulated ward environment in which to assess the ward-based care of surgical patients by clinicians of varying levels of experience (construct validation).
Increasing evidence points to the importance of the postoperative or ward-based phase of surgical care in determining patient outcomes. Ward-based care is determined by the clinician ward round, with the simulated ward environment potentially providing a safe environment for training and assessment.
A high-fidelity surgical ward environment was developed. Junior and senior trainees conducted ward rounds of 3 standardized surgical patients and were assessed using a checklist of assessment and management care processes, modified NOTECHS score, and fidelity questionnaire.
Nine senior and 9 junior trainees were observed. There was no significant difference in time taken to conduct the round (37.6 ± 2.7 vs 32.6 ± 1.9 minutes, P = 0.16). Senior trainees performed significantly more assessment processes (73% ± 2.8% vs 63% ± 2.5%, P = 0.016) and completed more management tasks (73% ± 4.5% vs 59.4% ± 5%, P = 0.058). Fifteen adverse events were committed by junior trainees versus 8 by seniors (P < 0.001). Seniors scored higher on nontechnical ability (NOTECHS score 21.8 ± 0.61 vs 18.1 ± 1.12, P = 0.017). All of subjects felt the ward, patients, and scenarios were realistic.
A high-fidelity, immersive, construct-valid ward simulator has been developed in which to observe and assess ward-based processes of surgical care.
评估在不同经验水平的临床医生中开发模拟病房环境以评估外科患者病房护理的可行性（结构验证）。
越来越多的证据表明，术后或病房阶段的外科护理对确定患者结局至关重要。病房护理由临床医生的病房查房决定，模拟病房环境可能为培训和评估提供安全的环境。
开发了一种高保真外科病房环境。初级和高级学员对 3 名标准化手术患者进行了病房查房，并使用评估和管理护理流程检查表、修改后的 NOTECHS 评分和保真度问卷进行评估。
观察了 9 名高级和 9 名初级学员。查房时间无显著差异（37.6 ± 2.7 分钟 vs 32.6 ± 1.9 分钟，P = 0.16）。高级学员执行了更多的评估流程（73% ± 2.8% vs 63% ± 2.5%，P = 0.016），完成了更多的管理任务（73% ± 4.5% vs 59.4% ± 5%，P = 0.058）。初级学员发生了 15 次不良事件，而高级学员发生了 8 次（P < 0.001）。非技术能力方面，高级学员得分更高（NOTECHS 评分 21.8 ± 0.61 分 vs 18.1 ± 1.12 分，P = 0.017）。所有受试者均认为病房、患者和场景逼真。
已经开发出一种高保真、沉浸式、结构验证的病房模拟器，可以观察和评估外科病房护理的基础流程。
