基于模拟的刻意练习掌握式学习可提高脊髓麻醉的临床操作表现。
Simulation-based mastery learning with deliberate practice improves clinical performance in spinal anesthesia.
作者信息
Udani Ankeet D, Macario Alex, Nandagopal Kiruthiga, Tanaka Maria A, Tanaka Pedro P
机构信息
Department of Anesthesiology, Perioperative and Pain Medicine, 300 Pasteur Drive, Room H3580, Stanford University, Stanford, CA 94305-5640, USA.
Department of Anesthesiology, Perioperative and Pain Medicine, 300 Pasteur Drive, Room H3580, Stanford University, Stanford, CA 94305-5640, USA ; Department of Anesthesiology, Perioperative and Pain Medicine, and Department of Health Research and Policy, Stanford University, Stanford, CA, USA.
出版信息
Anesthesiol Res Pract. 2014;2014:659160. doi: 10.1155/2014/659160. Epub 2014 Jul 16.
Introduction. Properly performing a subarachnoid block (SAB) is a competency expected of anesthesiology residents. We aimed to determine if adding simulation-based deliberate practice to a base curriculum improved performance of a SAB. Methods. 21 anesthesia residents were enrolled. After baseline assessment of SAB on a task-trainer, all residents participated in a base curriculum. Residents were then randomized so that half received additional deliberate practice including repetition and expert-guided, real-time feedback. All residents were then retested for technique. SABs on all residents' next three patients were evaluated in the operating room (OR). Results. Before completing the base curriculum, the control group completed 81% of a 16-item performance checklist on the task-trainer and this increased to 91% after finishing the base curriculum (P < 0.02). The intervention group also increased the percentage of checklist tasks properly completed from 73% to 98%, which was a greater increase than observed in the control group (P < 0.03). The OR time required to perform SAB was not different between groups. Conclusions. The base curriculum significantly improved resident SAB performance. Deliberate practice training added a significant, independent, incremental benefit. The clinical impact of the deliberate practice intervention in the OR on patient care is unclear.
引言。正确实施蛛网膜下腔阻滞（SAB）是麻醉科住院医师应具备的一项技能。我们旨在确定在基础课程中增加基于模拟的刻意练习是否能提高SAB的操作水平。方法。招募了21名麻醉科住院医师。在任务训练器上对SAB进行基线评估后，所有住院医师都参加了基础课程。然后将住院医师随机分组，其中一半接受额外的刻意练习，包括重复练习和专家指导的实时反馈。之后对所有住院医师的技术进行重新测试。在手术室（OR）对所有住院医师接下来的三名患者实施的SAB进行评估。结果。在完成基础课程之前，对照组在任务训练器上完成了16项操作检查表中的81%，完成基础课程后这一比例增加到91%（P < 0.02）。干预组正确完成检查表任务的百分比也从73%增加到98%，这一增幅大于对照组（P < 0.03）。两组实施SAB所需的手术室时间没有差异。结论。基础课程显著提高了住院医师的SAB操作水平。刻意练习培训带来了显著的、独立的、额外的益处。在手术室进行的刻意练习干预对患者护理的临床影响尚不清楚。
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