Malakooti Marcelo R, McBride Mary E, Mobley Bonnie, Goldstein Joshua L, Adler Mark D, McGaghie William C
J Grad Med Educ. 2015 Jun;7(2):181-6. doi: 10.4300/JGME-D-14-00516.1.
Management of status epilepticus (SE) in the pediatric population is highly time-sensitive. Failure to follow a standard management algorithm may be due to ineffective provider education, and can lead to unfavorable outcomes.
To design a learning module using high-fidelity simulation technology to teach mastery achievement of a hospital algorithm for managing SE.
Thirty pediatrics interns were enrolled. Using the Angoff method, an expert panel developed the minimal passing score, which defined mastery. Scoring of simulated performance was done by 2 observers. Sessions were digitally recorded. After the pretest, participants were debriefed on the algorithm and required to repeat the simulation. If mastery (minimal passing score) was not achieved, debriefing and the simulation were repeated until mastery was met. Once mastery was met, participants graded their comfort level in managing SE.
No participants achieved mastery at pretest. After debriefing and deliberate simulator training, all (n=30) achieved mastery of the algorithm: 30% achieved mastery after 1 posttest, 63% after a second, and 6.7% after a third. The Krippendorff α was 0.94, indicating strong interrater agreement. Participants reported more self-efficacy in managing SE, a preference for simulation-based education for learning practice-based algorithms of critical conditions, and highly rated the educational intervention.
A simulation-based mastery learning program using deliberate practice dramatically improves pediatrics residents' execution of a SE management protocol. Participants enjoyed and benefited from simulation education. Future applications include improving adherence to other hospital protocols.
小儿癫痫持续状态(SE)的管理对时间要求极高。未能遵循标准管理方案可能是由于对医疗人员的教育效果不佳,并且可能导致不良后果。
设计一个使用高保真模拟技术的学习模块,以教授对医院SE管理方案的掌握程度。
招募了30名儿科实习生。专家小组采用安格夫方法制定了最低及格分数,以此定义掌握程度。模拟表现由2名观察者评分。课程进行数字记录。在进行预测试后,向参与者讲解方案并要求他们重复模拟。如果未达到掌握程度(最低及格分数),则重复讲解和模拟,直到达到掌握程度。一旦达到掌握程度,参与者对自己管理SE的舒适度进行评分。
在预测试中没有参与者达到掌握程度。经过讲解和有针对性的模拟器训练后,所有30名参与者都掌握了该方案:30%在第一次后测中达到掌握程度,63%在第二次后测中达到,6.7%在第三次后测中达到。Krippendorff α为0.94,表明评分者间有很强的一致性。参与者表示在管理SE方面更有自我效能感,更喜欢基于模拟的教育来学习危急情况的基于实践的方案,并且对教育干预评价很高。
一个使用有针对性练习的基于模拟的掌握学习计划显著提高了儿科住院医师对SE管理方案的执行能力。参与者从模拟教育中获得了乐趣并从中受益。未来的应用包括提高对其他医院方案的依从性。