Singh Pritam, Aggarwal Rajesh, Pucher Philip H, Hashimoto Daniel A, Beyer-Berjot Laura, Bharathan Rasiah, Middleton Katherine E, Jones Joanne, Darzi Ara
Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK.
Division of Surgery, Department of Surgery & Cancer, Imperial College London, St. Mary's Hospital, London, UK; Department of Surgery, Faculty of Medicine, McGill University, Montreal, Canada.
Surgery. 2015 Mar;157(3):432-43. doi: 10.1016/j.surg.2014.09.024. Epub 2015 Jan 26.
The transition from student to intern can be challenging. The "August" or "July effect" describes increased errors and reduced patient safety during this transition. The study objectives were to develop, pilot, and evaluate clinical performance after an immersive simulation course for incoming interns.
Graduating students were recruited for a 1-week immersive simulation course. Controls received no simulation training. Primary outcome (at baseline, and 1 and 6 months) was clinical performance on Objective Structured Clinical Examinations (OSCE) of clinical procedures and surgical technical skills. Secondary outcomes were self-reported confidence and clinical procedure logbook data.
Nineteen students were recruited. Sixteen completed the 6-month follow-up, 10 in the intervention group and 6 in the control group. No differences were demonstrated between interventions and controls at baseline (OSCE [median, 66 vs. 78; P = .181], technical skills [48 vs. 52.5; P = .381], and confidence [101 vs 96; P = .368]). Interventions outperformed controls at 1 month (OSCE [111 vs 82; P = .001], technical skills [78.5 vs 63; P = .030], and confidence [142 vs. 119; P < .001]), and 6 months (OSCE [107 vs. 93; P = .007], technical skills [92.5 vs. 69; P = .044], and confidence [148 vs. 129; P = .022]). No differences were observed in numbers of clinical procedures performed at 1 (P = .958), 4 (P = .093), or 6 months (P = .713).
The immersive simulation course objectively improved subjects' clinical skills, technical skills, and confidence. Despite similar clinical experience as controls, the intervention group's improved performance persisted at 6 months follow-up. This feasible and effective intervention to ease transition from student to intern could reduce errors and enhance patient safety.
从学生转变为实习生可能具有挑战性。“八月”或“七月效应”描述了在此转变期间错误增加和患者安全降低的情况。本研究的目的是为即将入职的实习生开发、试点并评估沉浸式模拟课程后的临床绩效。
招募即将毕业的学生参加为期1周的沉浸式模拟课程。对照组未接受模拟培训。主要结局指标（在基线、1个月和6个月时）是临床操作和手术技术技能的客观结构化临床考试（OSCE）中的临床绩效。次要结局指标是自我报告的信心和临床操作日志数据。
招募了19名学生。16名完成了6个月的随访，干预组10名，对照组6名。在基线时，干预组和对照组之间未显示出差异（OSCE[中位数，66对78；P = 0.181]、技术技能[48对52.5；P = 0.381]和信心[101对96；P = 0.368]）。在1个月时，干预组的表现优于对照组（OSCE[111对82；P = 0.001]、技术技能[78.5对63；P = 0.030]和信心[142对119；P < 0.001]），在6个月时也是如此（OSCE[107对93；P = 0.007]、技术技能[92.5对69；P = 0.044]和信心[148对129；P = 0.022]）。在1个月（P = 0.958）、4个月（P = 0.093）或6个月（P = 0.713）时，两组进行的临床操作数量没有差异。
沉浸式模拟课程客观上提高了受试者的临床技能、技术技能和信心。尽管与对照组有相似的临床经验，但干预组在6个月随访时的改善表现仍然持续。这种缓解从学生到实习生转变的可行且有效的干预措施可以减少错误并提高患者安全。
