Baldwin Lydia J L, Jones Christopher M, Hulme Jonathan, Owen Andrew
Resuscitation for Medical Disciplines Research Group, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK.
Resuscitation for Medical Disciplines Research Group, College of Medical & Dental Sciences, University of Birmingham, Birmingham, UK; University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Resuscitation. 2015 Nov;96:199-207. doi: 10.1016/j.resuscitation.2015.08.010. Epub 2015 Aug 24.
Feedback is vital for the effective delivery of skills-based education. We sought to compare the sandwich technique and learning conversation structured methods of feedback delivery in competency-based basic life support (BLS) training.
Open randomised crossover study undertaken between October 2014 and March 2015 at the University of Birmingham, United Kingdom. Six-hundred and forty healthcare students undertaking a European Resuscitation Council (ERC) BLS course were enrolled, each of whom was randomised to receive teaching using either the sandwich technique or the learning conversation. Fifty-eight instructors were randomised to initially teach using either the learning conversation or sandwich technique, prior to crossing-over and teaching with the alternative technique after a pre-defined time period. Outcome measures included skill acquisition as measured by an end-of-course competency assessment, instructors' perception of teaching with each feedback technique and candidates' perception of the feedback they were provided with.
Scores assigned to use of the learning conversation by instructors were significantly more favourable than for the sandwich technique across all but two assessed domains relating to instructor perception of the feedback technique, including all skills-based domains. No difference was seen in either assessment pass rates (80.9% sandwich technique vs. 77.2% learning conversation; OR 1.2, 95% CI 0.85-1.84; p=0.29) or any domain relating to candidates' perception of their teaching technique.
CONCLUSIONS & RELEVANCE: This is the first direct comparison of two feedback techniques in clinical medical education using both quantitative and qualitative methodology. The learning conversation is preferred by instructors providing competency-based life support training and is perceived to favour skills acquisition.
反馈对于基于技能的教育的有效实施至关重要。我们试图比较在基于能力的基础生命支持（BLS）培训中反馈传递的三明治技术和学习对话结构化方法。
2014年10月至2015年3月在英国伯明翰大学进行了开放随机交叉研究。招募了640名参加欧洲复苏委员会（ERC）BLS课程的医学生，他们每个人都被随机分配接受使用三明治技术或学习对话的教学。58名教师被随机分配最初使用学习对话或三明治技术进行教学，在经过预定义的时间段后交叉并使用另一种技术进行教学。结果测量包括通过课程结束时的能力评估来衡量的技能获取、教师对每种反馈技术教学的看法以及候选人对他们所获得的反馈的看法。
在与教师对反馈技术的看法相关的所有评估领域中，除了两个领域外，教师对使用学习对话的评分明显比对三明治技术的评分更有利，包括所有基于技能的领域。在评估通过率（三明治技术为80.9%，学习对话为77.2%；比值比1.2，95%置信区间0.85 - 1.84；p = 0.29）或与候选人对其教学技术的看法相关的任何领域中均未发现差异。
这是首次在临床医学教育中使用定量和定性方法对两种反馈技术进行直接比较。提供基于能力的生命支持培训的教师更喜欢学习对话，并且认为它有利于技能获取。
