Diederich Emily, Mahnken Jonathan D, Rigler Sally K, Williamson Timothy L, Tarver Stephen, Sharpe Matthew R
From the Division of Pulmonary and Critical Care (E.D., T.L.W., M.R.S.), Department of Medicine, Department of Biostatistics (J.D.M.), Office of Scholarly, Academic and Research Mentoring (S.K.R.), Department of Medicine, and Department of Anesthesiology (S.T.), The University of Kansas Medical Center, Kansas City, KS.
Simul Healthc. 2015 Dec;10(6):360-367. doi: 10.1097/SIH.0000000000000117.
Simulation-based education for central venous catheter (CVC) insertion has been repeatedly documented to improve performance, but the impact of simulation model fidelity has not been described. The aim of this study was to examine the impact of the physical fidelity of the simulation model on learning outcomes for a simulation-based education program for CVC insertion.
Forty consecutive residents rotating through the medical intensive care unit of an academic medical center completed a simulation-based education program for CVC insertion. The curriculum was designed in accordance with the principles of deliberate practice and mastery learning. Each resident underwent baseline skills testing and was then randomized to training on a commercially available CVC model with high physical fidelity (High-Fi group) or a simply constructed model with low physical fidelity (Low-Fi group) in a noninferiority trial. Upon completion of their medical intensive care unit rotation 4 weeks later, residents returned for repeat skills testing on the high-fidelity model using a 26-item checklist.
The mean (SD) posttraining score on the 26-item checklist for the Low-Fi group was 23.8 (2.2) (91.5%) and was not inferior to the mean (SD) score for the High-Fi group of 22.5 (2.6) (86.5%) (P < 0.0001). Residents in both groups judged the training program to be highly useful despite perceiving a lesser degree of physical realism in the low-fidelity model compared with the high-fidelity model (P = 0.05).
Simulation-based education using equipment with low physical fidelity can achieve learning outcomes comparable with those with high-fidelity equipment, as long as other aspects of fidelity are maintained and robust educational principles are applied during the design of the curriculum.
基于模拟的中心静脉导管（CVC）插入术教育已被反复证明可提高操作表现，但模拟模型逼真度的影响尚未得到描述。本研究的目的是检验模拟模型的物理逼真度对基于模拟的CVC插入术教育项目学习成果的影响。
连续40名在一所学术医疗中心的医学重症监护病房轮转的住院医师完成了一项基于模拟的CVC插入术教育项目。该课程是根据刻意练习和掌握学习的原则设计的。在一项非劣效性试验中，每位住院医师都接受了基线技能测试，然后被随机分配到使用具有高物理逼真度的商用CVC模型进行培训（高逼真度组）或使用简单构建的低物理逼真度模型进行培训（低逼真度组）。4周后，住院医师完成医学重症监护病房轮转时，返回使用一份包含26项条目的检查表对高保真模型进行重复技能测试。
低逼真度组在26项检查表上的平均（标准差）培训后得分是23.8（2.2）（91.5%），不低于高逼真度组的平均（标准差）得分22.5（2.6）（86.5%）（P<0.0001）。尽管与高保真模型相比，两组住院医师都认为低保真模型的物理真实感较低，但两组住院医师都认为该培训项目非常有用（P = 0.05）。
只要在课程设计过程中保持逼真度的其他方面，并应用稳健的教育原则，使用低物理逼真度设备的基于模拟的教育可以实现与高保真设备相当的学习成果。
