PrOSTE：确定有效程序教学的关键组成部分。

The PrOSTE: identifying key components of effective procedural teaching.

作者信息

McSparron Jakob I, Ricotta Daniel N, Moskowitz Ari, Volpicelli Frank M, Roberts David H, Schwartzstein Richard M, Huang Grace C

机构信息

1 Department of Medicine, Division of Pulmonary, Critical Care, and Sleep Medicine.

出版信息

Ann Am Thorac Soc. 2015 Feb;12(2):230-4. doi: 10.1513/AnnalsATS.201406-237BC.

DOI:10.1513/AnnalsATS.201406-237BC

PMID:25564926

Abstract

RATIONALE

Novel approaches for faculty development and assessment of procedural teaching skills are needed to improve the procedural education of trainees. The Objective Structured Teaching Exercise (OSTE) entails a simulated encounter in which faculty are observed teaching a standardized student and has been used to evaluate teaching skills. Use of an OSTE to assess the teaching of central venous catheterization has not been reported.

OBJECTIVES

The purpose of this study was to develop a procedural OSTE for subclavian central venous catheter (CVC) insertion and to determine specific aspects of procedural teaching associated with improved skills in novices.

METHODS

Critical care faculty/fellows taught a standardized student to insert a CVC in a simulator. We assessed the instructor's teaching skills using rating scales to generate a procedural teaching score. After this encounter, the instructor taught novice medical students to place CVCs in simulators. Novices then independently placed catheters in simulators and were evaluated by trained observers using a checklist. Generalized estimating equations were used to examine the correlation between specific teaching behaviors and the novices' skills in CVC placement.

MEASUREMENTS AND MAIN RESULTS

We recruited 10 participants to serve as teachers and 30 preclinical medical students to serve as novice learners. The overall mean procedural teaching score was 85.5 (±15.4). Improved student performance was directly related to the degree to which the teacher "provided positive feedback" (β = 1.53, SE = 0.44, P = 0.001), "offered learner suggestions for improvement" (β = 1.40, SE = 0.35, P < 0.001), and "demonstrated the procedure in a step-by-step manner" (β = 2.50, SE = 0.45, P < 0.001). There was no significant correlation between total scores and student skills (β = 0.06, SE = 0.46, P = 0.18).

CONCLUSIONS

The OSTE is a standardized method to assess procedural teaching skills. Our findings suggest that specific aspects of procedural teaching should be emphasized to ensure effective transfer of psychomotor skills to trainees.

摘要

理论依据

需要采用新的方法来促进教员发展并评估操作教学技能，以改善实习生的操作教育。客观结构化教学练习（OSTE）包括模拟教学场景，在此场景中观察教员对一名标准化学生进行教学，并已被用于评估教学技能。尚未有关于使用OSTE评估中心静脉置管教学的报道。

目的

本研究的目的是开发一种用于锁骨下中心静脉导管（CVC）置入的操作OSTE，并确定与新手技能提升相关的操作教学的具体方面。

方法

重症监护教员/研究员在模拟器中指导一名标准化学生进行CVC置入操作。我们使用评分量表评估教员的教学技能，以得出操作教学分数。此次教学之后，教员在模拟器中指导医学专业新生进行CVC置入操作。然后新生在模拟器中独立进行置管操作，并由经过培训的观察员使用检查表进行评估。使用广义估计方程来检验特定教学行为与新生CVC置入技能之间的相关性。

测量指标和主要结果

我们招募了10名参与者作为教师，30名临床前医学生作为新手学习者。操作教学的总体平均分数为85.5（±15.4）。学生表现的提高与教师“提供积极反馈”的程度直接相关（β = 1.53，标准误 = 0.44，P = 0.001），“为学习者提供改进建议”（β = 1.40，标准误 = 0.35，P < 0.001），以及“逐步演示操作过程”（β = 2.50，标准误 = 0.45，P < 0.001）。总分与学生技能之间无显著相关性（β = 0.06，标准误 = 0.46，P = 0.18）。