提高麻醉医生在手术室表达意见的能力：基于模拟干预的随机对照试验及障碍与促进因素的定性分析

Improving Anesthesiologists' Ability to Speak Up in the Operating Room: A Randomized Controlled Experiment of a Simulation-Based Intervention and a Qualitative Analysis of Hurdles and Enablers.

作者信息

Raemer Daniel B, Kolbe Michaela, Minehart Rebecca D, Rudolph Jenny W, Pian-Smith May C M

机构信息

D.B. Raemer is associate professor of anaesthesia, Harvard Medical School, faculty member, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and senior director of clinical programs, Center for Medical Simulation, Boston, Massachusetts. M. Kolbe is faculty member, Organization, Work and Technology Group, Department of Management, Technology and Economics, ETH Zurich, and director, Simulation Center, University Hospital Zurich, Zurich, Switzerland. R.D. Minehart is assistant professor of anaesthesia, Harvard Medical School, faculty member, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and teaching faculty, Center for Medical Simulation, Boston, Massachusetts. J.W. Rudolph is assistant clinical professor of anaesthesia, Harvard Medical School, faculty member, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and director, Institute for Medical Simulation, Center for Medical Simulation, Boston, Massachusetts. M.C.M. Pian-Smith is associate professor of anaesthesia, Harvard Medical School, faculty member, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, and teaching faculty, Center for Medical Simulation, Boston, Massachusetts.

出版信息

Acad Med. 2016 Apr;91(4):530-9. doi: 10.1097/ACM.0000000000001033.

DOI:10.1097/ACM.0000000000001033

PMID:26703413

Abstract

PURPOSE

The authors addressed three questions: (1) Would a realistic simulation-based educational intervention improve speaking-up behaviors of practicing nontrainee anesthesiologists? (2) What would those speaking-up behaviors be when the issue emanated from a surgeon, a circulating nurse, or an anesthesiologist colleague? (3) What were the hurdles and enablers to speaking up in those situations?

METHOD

The authors conducted a simulation-based randomized controlled experiment from March 2008-February 2011 at the Center for Medical Simulation, Boston, Massachusetts. During a mandatory crisis management course for practicing nontrainee anesthesiologists from five Boston institutions, a 50-minute workshop on speaking up was conducted for intervention (n = 35) and control (n = 36) groups before or after, respectively, an experimental scenario with three events. The authors analyzed videos of the experimental scenarios and debriefing sessions.

RESULTS

No statistically significant differences between the intervention and control group subjects with respect to speaking-up actions were observed in any of the three events. The five most frequently mentioned hurdles to speaking up were uncertainty about the issue, stereotypes of others on the team, familiarity with the individual, respect for experience, and the repercussion expected. The five most frequently mentioned enablers were realizing the speaking-up problem, having a speaking-up rubric, certainty about the consequences of speaking up, familiarity with the individual, and having a second opinion or getting help.

CONCLUSIONS

An educational intervention alone was ineffective in improving the speaking-up behaviors of practicing nontrainee anesthesiologists. Other measures to change speaking-up behaviors could be implemented and might improve patient safety.

摘要

目的

作者探讨了三个问题：（1）基于现实模拟的教育干预能否改善非实习麻醉医师的直言行为？（2）当问题源自外科医生、巡回护士或麻醉医师同事时，那些直言行为会是怎样的？（3）在这些情况下直言的障碍和促成因素是什么？

方法

作者于2008年3月至2011年2月在马萨诸塞州波士顿的医学模拟中心进行了一项基于模拟的随机对照实验。在为来自波士顿五家机构的非实习麻醉医师举办的强制性危机管理课程期间，分别在有三个事件的实验场景之前或之后，为干预组（n = 35）和对照组（n = 36）举办了一场为期50分钟关于直言的研讨会。作者分析了实验场景和汇报环节的视频。

结果

在三个事件中的任何一个事件中，干预组和对照组受试者在直言行为方面均未观察到统计学上的显著差异。最常提到的五个直言障碍是对问题的不确定性、团队中他人的刻板印象、对个人的熟悉程度、对经验的尊重以及预期的后果。最常提到的五个促成因素是意识到直言问题、有直言准则、对直言后果的确定性、对个人的熟悉程度以及有第二种意见或获得帮助。