Takayesu James Kimo, Peak David, Stearns Dana
Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, 02114, USA.
Intern Emerg Med. 2017 Feb;12(1):99-102. doi: 10.1007/s11739-016-1439-1. Epub 2016 Mar 28.
Emergency medicine (EM) training mandates that residents be able to competently perform low-frequency critical procedures upon graduation. Simulation is the main method of training in addition to clinical patient care. Access to cadaver-based training is limited due to cost and availability. The relative fidelity and perceived value of cadaver-based simulation training is unknown. This pilot study sought to describe the relative value of cadaver training compared to simulation for cricothyrotomy and tube thoracostomy. To perform a pilot study to assess whether there is a significant difference in fidelity and educational experience of cadaver-based training compared to simulation training. To understand how important this difference is in training residents in low-frequency procedures. Twenty-two senior EM residents (PGY3 and 4) who had completed standard simulation training on cricothyrotomy and tube thoracostomy participated in a formalin-fixed cadaver training program. Participants were surveyed on the relative fidelity of the training using a 100 point visual analogue scale (VAS) with 100 defined as equal to performing the procedure on a real patient. Respondents were also asked to estimate how much the cadaveric training improved the comfort level with performing the procedures on a scale between 0 and 100 %. Open-response feedback was also collected. The response rate was 100 % (22/22). The average fidelity of the cadaver versus simulation training was 79.9 ± 7.0 vs. 34.7 ± 13.4 for cricothyrotomy (p < 0.0001) and 86 ± 8.6 vs. 38.4 ± 19.3 for tube thoracostomy (p < 0.0001). Improvement in comfort levels performing procedures after the cadaveric training was rated as 78.5 ± 13.3 for tube thoracostomy and 78.7 ± 14.3 for cricothyrotomy. All respondents felt this difference in fidelity to be important for procedural training with 21/22 respondents specifically citing the importance of superior landmark and tissue fidelity compared to simulation training. Cadaver-based training provides superior landmark and tissue fidelity compared to simulation training and may be a valuable addition to EM residency training for certain low-frequency procedures.
急诊医学（EM）培训要求住院医师在毕业时能够熟练执行低频关键操作。除临床患者护理外，模拟是主要的培训方法。由于成本和可用性，基于尸体的培训机会有限。基于尸体的模拟培训的相对逼真度和感知价值尚不清楚。这项试点研究旨在描述与模拟相比，尸体培训在环甲膜切开术和胸腔闭式引流术方面的相对价值。进行一项试点研究，以评估与模拟培训相比，基于尸体的培训在逼真度和教育体验方面是否存在显著差异。了解这种差异在培训住院医师进行低频操作方面有多重要。22名完成了环甲膜切开术和胸腔闭式引流术标准模拟培训的急诊医学高级住院医师（PGY3和PGY4）参加了一个用福尔马林固定的尸体培训项目。使用100分视觉模拟量表（VAS）对参与者进行培训相对逼真度的调查，100分定义为等同于在真实患者身上进行操作。还要求受访者估计尸体培训在0%至100%的范围内提高了进行操作的舒适度的程度。还收集了开放式反馈。回复率为100%（22/22）。对于环甲膜切开术，尸体培训与模拟培训的平均逼真度分别为79.9±7.0和34.7±13.4（p<0.0001）；对于胸腔闭式引流术，分别为86±8.6和38.4±19.3（p<0.0001）。尸体培训后进行操作的舒适度提高程度，胸腔闭式引流术评分为78.5±13.3，环甲膜切开术评分为78.7±14.3。所有受访者都认为这种逼真度差异对操作培训很重要，22名受访者中有21名特别提到与模拟培训相比， superior landmark（此处原文有误，推测可能是“更好的解剖标志”之类意思）和组织逼真度的重要性。与模拟培训相比，基于尸体的培训提供了更好的解剖标志和组织逼真度，对于某些低频操作，可能是急诊医学住院医师培训的一个有价值的补充。
