模拟器培训提高了住院医师经食管超声心动图检查的水平。

Simulator training enhances resident performance in transesophageal echocardiography.

机构信息

From the Department of Anesthesiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (N.A.F., A.V.B., H.A., S.M.M., L.M.K., E.C.T., D.A.Z., P.A.K.), and Outcomes Research Consortium, Cleveland, Ohio (H.A., P.A.K.).

出版信息

Anesthesiology. 2014 Jan;120(1):149-59. doi: 10.1097/ALN.0000000000000063.

DOI:10.1097/ALN.0000000000000063

PMID:24398732

Abstract

BACKGROUND

Standardized training via simulation as an educational adjunct may lead to a more rapid and complete skill achievement. The authors hypothesized that simulation training will also enhance performance in transesophageal echocardiography image acquisition among anesthesia residents.

METHODS

A total of 42 clinical anesthesia residents were randomized to one of two groups: a control group, which received traditional didactic training, and a simulator group, whose training used a transesophageal echocardiography-mannequin simulator. Each participating resident was directed to obtain 10 commonly used standard views on an anesthetized patient under attending supervision. Each of the 10 selected echocardiographic views were evaluated on a grading scale of 0 to 10, according to predetermined criteria. The effect of the intervention was assessed by using a linear mixed model implemented in SAS 9.3 (SAS Institute Inc., Cary, NC).

RESULTS

Residents in the simulation group obtained significantly higher-quality images with a mean total image quality score of 83 (95% CI, 74 to 92) versus the control group score of 67 (95% CI, 58 to 76); P = 0.016. On average, 71% (95% CI, 58 to 85) of images acquired by each resident in the simulator group were acceptable for clinical use compared with 48% (95% CI, 35 to 62) in the control; P = 0.021. Additionally, the mean difference in score between training groups was the greatest for the clinical anesthesia-1 residents (difference 24; P = 0.031; n = 7 per group) and for those with no previous transesophageal echocardiography experience (difference 26; P = 0.005; simulator n = 13; control n = 11).

CONCLUSION

Simulation-based transesophageal echocardiography education enhances image acquisition skills in anesthesiology residents.

摘要

背景

通过模拟进行标准化培训作为一种教育辅助手段可能会导致更快、更全面的技能掌握。作者假设，模拟培训也将提高麻醉住院医师进行经食管超声心动图图像采集的表现。

方法

共有 42 名临床麻醉住院医师被随机分为两组：对照组接受传统的理论培训，模拟组则使用经食管超声心动图模拟人进行培训。每位参与的住院医师在主治医生的监督下，对一名麻醉患者进行 10 种常用标准视图的获取。根据预定标准，对这 10 种选定的超声心动图视图中的每一种进行 0 到 10 的评分。使用 SAS 9.3（SAS Institute Inc.，Cary，NC）中实现的线性混合模型评估干预效果。

结果

模拟组的住院医师获得了质量更高的图像，平均总图像质量评分为 83（95%置信区间，74 至 92），而对照组的评分则为 67（95%置信区间，58 至 76）；P = 0.016。平均而言，模拟组中每位住院医师获取的可用于临床使用的图像比例为 71%（95%置信区间，58 至 85），而对照组的这一比例为 48%（95%置信区间，35 至 62）；P = 0.021。此外，在训练组之间的评分差异最大的是临床麻醉-1 住院医师（差异 24；P = 0.031；每组 n = 7）和没有经食管超声心动图经验的住院医师（差异 26；P = 0.005；模拟组 n = 13；对照组 n = 11）。