Fletcher J D, Wind Alexander P
Science and Technology Division, Institute for Defense Analyses, 4850 Mark Center Dr., Alexandria, VA 22311.
Mil Med. 2013 Oct;178(10 Suppl):37-46. doi: 10.7205/MILMED-D-13-00258.
This article reviews simulation used for medical training, techniques for assessing simulation-based training, and cost analyses that can be included in such assessments. Simulation in medical training appears to take four general forms: human actors who are taught to simulate illnesses and ailments in standardized ways; virtual patients who are generally presented via computer-controlled, multimedia displays; full-body manikins that simulate patients using electronic sensors, responders, and controls; and part-task anatomical simulations of various body parts and systems. Techniques for assessing costs include benefit-cost analysis, return on investment, and cost-effectiveness analysis. Techniques for assessing the effectiveness of simulation-based medical training include the use of transfer effectiveness ratios and incremental transfer effectiveness ratios to measure transfer of knowledge and skill provided by simulation to the performance of medical procedures. Assessment of costs and simulation effectiveness can be combined with measures of transfer using techniques such as isoperformance analysis to identify ways of minimizing costs without reducing performance effectiveness or maximizing performance without increasing costs. In sum, economic analysis must be considered in training assessments if training budgets are to compete successfully with other requirements for funding.
本文回顾了用于医学培训的模拟、基于模拟的培训评估技术以及此类评估中可包含的成本分析。医学培训中的模拟似乎有四种一般形式：接受培训以标准化方式模拟疾病和病痛的真人演员；通常通过计算机控制的多媒体显示器呈现的虚拟患者；使用电子传感器、响应器和控制器模拟患者的全身人体模型；以及对身体各个部位和系统的部分任务解剖模拟。评估成本的技术包括效益成本分析、投资回报率和成本效益分析。评估基于模拟的医学培训有效性的技术包括使用转移效率比率和增量转移效率比率来衡量模拟提供的知识和技能向医疗程序执行的转移。成本评估和模拟有效性评估可以与使用等绩效分析等技术的转移措施相结合，以确定在不降低绩效有效性的情况下最小化成本或在不增加成本的情况下最大化绩效的方法。总之，如果培训预算要成功地与其他资金需求竞争，那么在培训评估中必须考虑经济分析。
