Pucher Philip H, Aggarwal Rajesh, Singh Pritam, Srisatkunam Tharanny, Twaij Ahmed, Darzi Ara
*Department of Surgery and Cancer, Imperial College London, London, United Kingdom; and †Department of Gastrointestinal Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia.
Ann Surg. 2014 Aug;260(2):236-43. doi: 10.1097/SLA.0000000000000557.
This study aimed to investigate the effects of a simulation-based curriculum for ward-based care on ward round (WR) performance.
Variability in surgical outcomes does not relate to surgical skill alone. Prevention, diagnosis, and treatment of peri- and postoperative morbidity are dependent on provision of high-quality ward-based care. The focal point of this is the surgical WR. Although WR conduct is learned primarily through experience, a simulated environment and validated assessment tools may enable measurement and enhancement of WR quality.
Junior surgical residents were randomized either to a half-day educational intervention with lectures, structured feedback, and debriefing, or to standard practice (control). All conducted a standardized, validated, simulated WR of 3 patients. Surgical Ward Care Assessment Tool and W-NOTECHS rating scales were used for technical and nontechnical skills assessment, respectively, and compared between groups. Subjects completed pre- and posttest confidence questionnaires and feedback forms.
Twenty-nine trainees were randomized to intervention (n = 14) or control (n = 15). Baseline confidence and demographics were equal between groups. Intervention group demonstrated better patient assessment: 63.5 ± 8.1% (control) versus 79.8 ± 11.9% (P = 0.002), management 56.0% ± 19.7% versus 72.2 ± 10.3% (P = 0.014), and nontechnical skills: W-NOTECHS 17.75 ± 2.06 versus 23.33 ± 1.21 (P < 0.001). Hundred percent of subjects felt that the curriculum improved their practice.
Conducting WRs is a crucial skill but not currently subject to formal training. Implementation of a comprehensive curriculum for surgical WRs led to significant improvement in quality of patient assessment, management, and nontechnical skills. Improved WR performance may lead to earlier identification and amelioration of complications and improve patient outcomes.
本研究旨在调查基于模拟的病房护理课程对查房（WR）表现的影响。
手术结果的差异不仅仅与手术技能有关。围手术期和术后发病率的预防、诊断和治疗取决于高质量的病房护理。其重点是外科查房。虽然查房主要通过经验来学习，但模拟环境和经过验证的评估工具可能有助于衡量和提高查房质量。
初级外科住院医师被随机分为两组，一组接受为期半天的教育干预，包括讲座、结构化反馈和汇报总结，另一组接受标准实践（对照组）。两组均对3名患者进行标准化、经过验证的模拟查房。分别使用外科病房护理评估工具和W-NOTECHS评分量表对技术和非技术技能进行评估，并在组间进行比较。受试者完成了测试前和测试后的信心问卷及反馈表。
29名受训者被随机分为干预组（n = 14）或对照组（n = 15）。两组的基线信心和人口统计学特征相同。干预组在患者评估方面表现更好：63.5 ± 8.1%（对照组）对79.8 ± 11.9%（P = 0.002），管理方面为56.0% ± 19.7%对72.2 ± 10.3%（P = 0.014），非技术技能方面：W-NOTECHS评分为17.75 ± 2.06对23.33 ± 1.21（P < 0.001）。100%的受试者认为该课程改进了他们的实践。
进行查房是一项关键技能，但目前尚未接受正规培训。实施全面的外科查房课程可显著提高患者评估、管理和非技术技能的质量。查房表现的改善可能会导致更早地识别和改善并发症，并改善患者预后。
