Washington University in St. Louis School of Medicine, Doris Duke Clinical Research Fellowship, St. Louis, MO 63110, USA.
Pediatr Blood Cancer. 2013 Sep;60(9):1492-8. doi: 10.1002/pbc.24558. Epub 2013 Apr 30.
Sickle cell disease (SCD) is a rare disorder with cardinal features including hospitalization for vaso-occlusive pain episodes, acute pulmonary injury, and increased infection rates. For physician-trainees, learning optimal SCD management is challenging because of limited exposure to life threatening complications requiring timely interventions.
To create, demonstrate reliability, and validate simulation-based, acute care SCD scenarios for physician-trainees, seven scenarios were derived from SCD patient cases. For each scenario, participants had 5 minutes to complete diagnostic and treatment interventions. Participants were divided into two groups based on clinical experience: interns or residents/fellows. Two raters scored performances using diagnostic and therapeutic checklists--indicating whether specific actions were performed and a global, 1 (poor) to 9 (excellent), rating. Scenario scores were calculated by averaging rater scores on each metric. Reliability was defined through uniformity in rater scoring and consistency of participant performance over scenarios. Validity was demonstrated by the performance gradient where the more experienced trainees outperform those early in training.
Twenty-eight pediatric residents and hematology fellows took part in the study. Reliability for assessment scores overall was moderate. Performance on all but one scenario was moderately predictive of overall performance. Senior resident/fellows performed significantly better than interns. Positive associations existed between overall performance scores (P < 0.01) and months of postgraduate training (P < 0.01).
Mannequin-based simulation is a novel method for teaching pediatric residents SCD-specific acute care skills. The assessment provided reliable and valid measures of trainees' performance. Further studies are needed to determine simulation's utility in education and evaluation.
镰状细胞病（SCD）是一种罕见的疾病，其主要特征包括血管阻塞性疼痛发作、急性肺损伤和感染率增加。对于医师培训生来说，由于接触到需要及时干预的危及生命的并发症的机会有限，因此学习最佳的 SCD 管理方法具有挑战性。
为了为医师培训生创建、证明可靠性并验证基于模拟的急性护理 SCD 场景，从 SCD 患者病例中得出了七个场景。对于每个场景，参与者有 5 分钟的时间来完成诊断和治疗干预。根据临床经验，参与者分为两组：实习生或住院医师/研究员。两名评分员使用诊断和治疗清单对表现进行评分，表明是否执行了特定操作以及 1（差）至 9（优）的整体评分。通过在每个指标上平均评分员的评分来计算场景分数。可靠性是通过评分员评分的一致性和参与者在场景中的一致性来定义的。通过表现梯度来证明有效性，即经验丰富的培训生表现优于早期培训的培训生。
28 名儿科住院医师和血液学研究员参加了这项研究。评估分数的可靠性总体上是中等的。除了一个场景之外，所有场景的表现都对整体表现具有中等预测性。高级住院医师/研究员的表现明显优于实习生。总体表现得分之间存在正相关（P<0.01），与毕业后培训的月份之间存在正相关（P<0.01）。
基于人体模型的模拟是一种教授儿科住院医师 SCD 特定急性护理技能的新方法。该评估提供了对学员表现的可靠和有效的衡量标准。需要进一步的研究来确定模拟在教育和评估中的效用。
