Multak Nina, Newell Karen, Spear Sherrie, Scalese Ross J, Issenberg S Barry
Nina Multak, MPAS, PA-C, is an associate clinical professor at the Drexel University Physician Assistant Program, Philadelphia, Pennsylvania. Karen Newell, MMSc, PA-C, is an assistant professor at the Emory University Physician Assistant Program, Atlanta, Georgia. Sherrie Spear, MHS, PA-C, is an assistant professor at the Duke University Physician Assistant Program, Durham, North Carolina. Ross J. Scalese, MD, is an associate professor of Medicine and director of Educational Technology Development at the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida. S. Barry Issenberg, MD, is the associate dean for Research in Medical Education, professor of Medicine, and director of the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida.
J Physician Assist Educ. 2015 Jun;26(2):70-6. doi: 10.1097/JPA.0000000000000021.
Research demonstrates limitations in the ability of health care trainees/practitioners, including physician assistants (PAs), to identify important cardiopulmonary examination findings and diagnose corresponding conditions. Studies also show that simulation-based training leads to improved performance and that these skills can transfer to real patients. This study evaluated the effectiveness of a newly developed curriculum incorporating simulation with deliberate practice for teaching cardiopulmonary physical examination/bedside diagnosis skills in the PA population.
This multi-institutional study used a pretest/posttest design. Participants, PA students from 4 different programs, received a standardized curriculum including instructor-led activities interspersed among small-group/independent self-study time. Didactic sessions and independent study featured practice with the "Harvey" simulator and use of specially developed computer-based multimedia tutorials. Preintervention: participants completed demographic questionnaires, rated self-confidence, and underwent baseline evaluation of knowledge and cardiopulmonary physical examination skills. Students logged self-study time using various learning resources. Postintervention: students again rated self-confidence and underwent repeat cognitive/performance testing using equivalent written/simulator-based assessments.
Physician assistant students (N = 56) demonstrated significant gains in knowledge, cardiac examination technique, recognition of total cardiac findings, identification of key auscultatory findings (extra heart sounds, systolic/diastolic murmurs), and the ability to make correct diagnoses. Learner self-confidence also improved significantly.
This study demonstrated the effectiveness of a simulation-based curriculum for teaching essential physical examination/bedside diagnosis skills to PA students. Its results reinforce those of similar/previous research, which suggest that simulation-based training is most effective under certain educational conditions. Future research will include subgroup analyses/correlation of other variables to explore best features/uses of simulation technology for training PAs.
研究表明，包括医师助理（PA）在内的医疗保健学员/从业者识别重要心肺检查结果并诊断相应病症的能力存在局限性。研究还表明，基于模拟的培训可提高表现，且这些技能可应用于真实患者。本研究评估了一项新开发的课程的有效性，该课程将模拟与刻意练习相结合，用于教授PA人群的心肺体格检查/床边诊断技能。
这项多机构研究采用了前测/后测设计。参与者为来自4个不同项目的PA学生，他们接受了标准化课程，其中包括穿插在小组/独立自学时间中的教师主导活动。理论课程和独立学习包括使用“哈维”模拟器进行练习以及使用专门开发的基于计算机的多媒体教程。干预前：参与者完成人口统计学问卷，对自信心进行评分，并接受知识和心肺体格检查技能的基线评估。学生使用各种学习资源记录自学时间。干预后：学生再次对自信心进行评分，并使用等效的书面/基于模拟器的评估进行重复的认知/表现测试。
医师助理学生（N = 56）在知识、心脏检查技术、识别总的心脏检查结果、识别关键听诊结果（额外心音、收缩期/舒张期杂音）以及做出正确诊断的能力方面有显著提高。学习者的自信心也有显著提高。
本研究证明了基于模拟的课程对于向PA学生教授基本体格检查/床边诊断技能的有效性。其结果强化了类似/先前研究的结果，这些研究表明基于模拟的培训在某些教育条件下最为有效。未来的研究将包括亚组分析/其他变量的相关性，以探索模拟技术培训PA的最佳特点/用途。
