Mills Brennen W, Carter Owen B-J, Rudd Cobie J, Claxton Louise A, Ross Nathan P, Strobel Natalie A
From the Office of the Deputy Vice Chancellor (Strategic Partnerships) (B.W.M., O.B.J.C., C.J.R.) and School of Medical Sciences (L.A.C.), Edith Cowan University, Joondalup Western Australia; School of Medicine (N.P.R.), Deakin University, Geelong, Victoria, Australia; and School of Paediatrics and Child Health (N.S.), University of Western Australia, Crawley, Western Australia.
Simul Healthc. 2016 Feb;11(1):10-8. doi: 10.1097/SIH.0000000000000119.
High-fidelity simulation-based training is often avoided for early-stage students because of the assumption that while practicing newly learned skills, they are ill suited to processing multiple demands, which can lead to "cognitive overload" and poorer learning outcomes. We tested this assumption using a mixed-methods experimental design manipulating psychological immersion.
Thirty-nine randomly assigned first-year paramedicine students completed low- or high-environmental fidelity simulations [low-environmental fidelity simulations (LF(en)S) vs. high-environmental fidelity simulation (HF(en)S)] involving a manikin with obstructed airway (SimMan3G). Psychological immersion and cognitive burden were determined via continuous heart rate, eye tracking, self-report questionnaire (National Aeronautics and Space Administration Task Load Index), independent observation, and postsimulation interviews. Performance was assessed by successful location of obstruction and time-to-termination.
Eye tracking confirmed that students attended to multiple, concurrent stimuli in HF(en)S and interviews consistently suggested that they experienced greater psychological immersion and cognitive burden than their LF(en)S counterparts. This was confirmed by significantly higher mean heart rate (P < 0.001) and National Aeronautics and Space Administration Task Load Index mental demand (P < 0.05). Although group allocation did not influence the proportion of students who ultimately revived the patient (58% vs. 30%, P < 0.10), the HF(en)S students did so significantly more quickly (P < 0.01). The LF(en)S students had low immersion resulting in greater assessment anxiety.
High-environmental fidelity simulation engendered immersion and a sense of urgency in students, whereas LF(en)S created assessment anxiety and slower performance. We conclude that once early-stage students have learned the basics of a clinical skill, throwing them in the "deep end" of high-fidelity simulation creates significant additional cognitive burden but this has considerable educational merit.
基于高保真模拟的培训通常会被早期阶段的学生所回避，原因是人们认为在练习新学技能时，他们不适合处理多种需求，这可能导致“认知过载”和较差的学习效果。我们使用一种操纵心理沉浸感的混合方法实验设计对这一假设进行了测试。
39名随机分配的一年级护理专业学生完成了低或高环境逼真度模拟[低环境逼真度模拟（LF(en)S）与高环境逼真度模拟（HF(en)S）]，模拟内容为一名气道阻塞的人体模型（SimMan3G）。通过连续心率、眼动追踪、自我报告问卷（美国国家航空航天局任务负荷指数）、独立观察和模拟后访谈来确定心理沉浸感和认知负担。通过成功定位阻塞部位和终止时间来评估表现。
眼动追踪证实，学生们在HF(en)S中关注多个同时出现的刺激，访谈也一致表明，他们比LF(en)S组的学生经历了更大的心理沉浸感和认知负担。平均心率显著更高（P < 0.001）以及美国国家航空航天局任务负荷指数中的心理需求更高（P < 0.05）证实了这一点。尽管分组并未影响最终使患者复苏的学生比例（58%对30%，P < 0.10），但HF(en)S组的学生复苏速度明显更快（P < 0.01）。LF(en)S组的学生沉浸感较低，导致评估焦虑感更强。
高环境逼真度模拟在学生中产生了沉浸感和紧迫感，而LF(en)S则造成了评估焦虑和表现较慢的情况。我们得出结论，一旦早期阶段的学生掌握了临床技能的基础知识，将他们置于高保真模拟的“深水区”会带来显著的额外认知负担，但这具有相当大的教育价值。
