Ross A J, Reedy G B, Roots A, Jaye P, Birns J
Glasgow Dental School, University of Glasgow, 378 Sauchiehall Street, Glasgow, G2 3JZ, UK.
Simulation and Interactive Learning (SaIL) Centre, St Thomas' Hospital, King's Health Partners, London, UK.
BMC Med Educ. 2015 Sep 2;15:143. doi: 10.1186/s12909-015-0423-1.
Stroke is a clinical priority requiring early specialist assessment and treatment. A London (UK) stroke strategy was introduced in 2010, with Hyper Acute Stroke Units (HASUs) providing specialist and high dependency care. To support increased numbers of specialist staff, innovative multisite multiprofessional simulation training under a standard protocol-based curriculum took place across London. This paper reports on an independent evaluation of the HASU training programme. The main aim was to evaluate mechanisms for behaviour change within the training design and delivery, and impact upon learners including potential transferability to the clinical environment.
The evaluation utilised the Behaviour Change Wheel framework. Procedures included: mapping training via the framework; examination of course material; direct and video-recorded observations of courses; pre-post course survey sheet; and follow up in-depth interviews with candidates and faculty.
Patient management skills and trainee confidence were reportedly increased post-course (post-course median 6 [IQ range 5-6.33]; pre-course median 5 [IQ range 4.67-5.83]; z = 6.42, P < .001). Thematic analysis showed that facilitated 'debrief' was the key agent in supporting both clinical and non-clinical skills. Follow up interviews in practice showed some sustained effects such as enthusiasm for role, and a focus on situational awareness, prioritization and verbalising thoughts. Challenges in standardising a multi-centre course included provision for local context/identity.
Pan-London simulation training under the London Stroke Model had positive outcomes in terms of self-reported skills and motivation. These effects persisted to an extent in practice, where staff could recount applications of learning. The evaluation demonstrated that a multiple centre simulation programme congruent with clinical practice can provide valuable standard training opportunities that support patient care.
中风是临床重点，需要早期专科评估和治疗。2010年英国伦敦推出了中风战略，超急性中风单元（HASUs）提供专科和高度依赖护理。为了支持增加专科工作人员数量，伦敦各地在基于标准协议的课程下开展了创新的多地点多专业模拟培训。本文报告了对HASU培训项目的独立评估。主要目的是评估培训设计和实施过程中行为改变的机制，以及对学习者的影响，包括潜在的临床环境可转移性。
评估采用行为改变轮框架。程序包括：通过该框架绘制培训图；检查课程材料；对课程进行直接和视频记录观察；课程前后调查问卷；以及对学员和教员进行后续深入访谈。
据报告，课程结束后患者管理技能和学员信心有所提高（课程后中位数为6[智商范围5 - 6.33]；课程前中位数为5[智商范围4.67 - 5.83]；z = 6.42，P < 0.001）。主题分析表明，促进“汇报”是支持临床和非临床技能的关键因素。实践中的后续访谈显示出一些持续的效果，如对角色的热情，以及对情景意识、优先级确定和表达想法的关注。标准化多中心课程的挑战包括考虑当地背景/特色。
伦敦中风模式下的泛伦敦模拟培训在自我报告的技能和动机方面取得了积极成果。这些效果在实践中在一定程度上持续存在，工作人员可以讲述学习的应用情况。评估表明，与临床实践相一致的多中心模拟项目可以提供支持患者护理的有价值的标准培训机会。
