Mema Briseida, Harris Ilene
a Department of Critical Care Medicine , University of Toronto , Toronto , Ontario , Canada.
b Department of Medical Education , University of Illinois at Chicago , Chicago , Illinois , USA.
Teach Learn Med. 2016;28(2):115-24. doi: 10.1080/10401334.2016.1146604.
PHENOMENON: Ultrasound-guided central venous line insertion is currently the standard of care. Randomized controlled trials and systematic reviews show that simulation is superior to apprenticeship training. The purpose of this study is to explore, from the perspectives of participants in a simulation-training program, the factors that help or hinder the transfer of skills from simulation to practice.
Purposeful sampling was used to select and study the experience and perspective of novice fellows after they had completed simulation training and then performed ultrasound-guided central venous line in practice. Seven novice pediatric intensive care unit fellows and six supervising faculty in a university-affiliated academic center in a large urban city were recruited between September 2012 and January 2013. We conducted a qualitative study using semistructured interviews as our data source, employing a constructivist, grounded theory methodology.
Both curricular and real-life factors influence the transfer of skills from simulation to practice and the overall performance of trainees. Clear instructions, the opportunity to practice to mastery, one-on-one observation with feedback, supervision, and further real-life experiences were perceived as factors that facilitated the transfer of skills. Concern for patient welfare, live trouble shooting, complexity of the intensive care unit environment, and the procedure itself were perceived as real-life factors that hindered the transfer of skills. Insights: As more studies confirm the superiority of simulation training versus apprenticeship training for initial student learning, the faculty should gain insight into factors that facilitate and hinder the transfer of skills from simulation to bedside settings and impact learners' performances. As simulation further augments clinical learning, efforts should be made to modify the curricular and bedside factors that facilitate transfer of skills from simulation to practice settings.
现象：超声引导下中心静脉置管目前是护理标准。随机对照试验和系统评价表明，模拟训练优于学徒式培训。本研究的目的是从模拟训练项目参与者的角度，探索有助于或阻碍技能从模拟训练向实际操作转移的因素。
采用目的抽样法，选取并研究新手学员在完成模拟训练后，在实际操作中进行超声引导下中心静脉置管的经验和观点。2012年9月至2013年1月期间，在一个大城市的大学附属学术中心招募了7名儿科重症监护病房新手学员和6名指导教师。我们采用半结构化访谈作为数据来源进行定性研究，采用建构主义扎根理论方法。
课程因素和现实生活因素都会影响技能从模拟训练向实际操作的转移以及学员的整体表现。清晰的指导、练习至熟练掌握的机会、一对一观察与反馈、监督以及更多的现实生活经验被视为促进技能转移的因素。对患者福利的关注、现场故障排除、重症监护病房环境的复杂性以及操作本身被视为阻碍技能转移的现实生活因素。见解：随着越来越多的研究证实模拟训练相对于学徒式培训在初始学生学习方面的优越性，教师应深入了解有助于和阻碍技能从模拟训练向床边环境转移并影响学习者表现的因素。随着模拟训练进一步增强临床学习效果，应努力改变促进技能从模拟训练向实际操作环境转移的课程因素和床边因素。
