Gregg Shea C, Heffernan Daithi S, Connolly Michael D, Stephen Andrew H, Leuckel Stephanie N, Harrington David T, Machan Jason T, Adams Charles A, Cioffi William G
From the Bridgeport Hospital, Yale-New Haven Health System (S.C.G.), Bridgeport, Connecticut; and Warren Alpert School of Medicine of Brown University (D.H., M.D.C., A.H.S., S.N.L., D.T.H., J.T.M., C.A.A., and W.G.C.), Rhode Island Hospital, Providence, Rhode Island.
J Trauma Acute Care Surg. 2016 Oct;81(4):729-34. doi: 10.1097/TA.0000000000001186.
Limited data exist on how to develop resident leadership and communication skills during actual trauma resuscitations.
An evaluation tool was developed to grade senior resident performance as the team leader during full-trauma-team activations. Thirty actions that demonstrated the Accreditation Council for Graduate Medical Education core competencies were graded on a Likert scale of 1 (poor) to 5 (exceptional). These actions were grouped by their respective core competencies on 5 × 7-inch index cards. In Phase 1, baseline performance scores were obtained. In Phase 2, trauma-focused communication in-services were conducted early in the academic year, and immediate, personalized feedback sessions were performed after resuscitations based on the evaluation tool. In Phase 3, residents received only evaluation-based feedback following resuscitations.
In Phase 1 (October 2009 to April 2010), 27 evaluations were performed on 10 residents. In Phase 2 (April 2010 to October 2010), 28 evaluations were performed on nine residents. In Phase 3 (October 2010 to January 2012), 44 evaluations were performed on 13 residents. Total scores improved significantly between Phases 1 and 2 (p = 0.003) and remained elevated throughout Phase 3. When analyzing performance by competency, significant improvement between Phases 1 and 2 (p < 0.05) was seen in all competencies (patient care, knowledge, system-based practice, practice-based learning) with the exception of "communication and professionalism" (p = 0.56). Statistically similar scores were observed between Phases 2 and 3 in all competencies with the exception of "medical knowledge," which showed ongoing significant improvement (p = 0.003).
Directed resident feedback sessions utilizing data from a real-time, competency-based evaluation tool have allowed us to improve our residents' abilities to lead trauma resuscitations over a 30-month period. Given pressures to maximize clinical educational opportunities among work-hour constraints, such a model may help decrease the need for costly simulation-based training.
Therapeutic study, level III.
关于如何在实际创伤复苏过程中培养住院医师的领导能力和沟通技巧的数据有限。
开发了一种评估工具，用于在全创伤团队启动期间对担任团队领导者的高级住院医师的表现进行评分。对30项体现毕业后医学教育认证委员会核心能力的行为，按照从1（差）到5（优秀）的李克特量表进行评分。这些行为根据各自的核心能力分组记录在5×7英寸的索引卡上。在第1阶段，获取基线表现分数。在第2阶段，在学年早期开展以创伤为重点的沟通在职培训，并在复苏后根据评估工具进行即时、个性化的反馈会议。在第3阶段，住院医师在复苏后仅接受基于评估的反馈。
在第第1阶段（2009年10月至2010年4月），对10名住院医师进行了27次评估。在第2阶段（2010年4月至2010年10月），对9名住院医师进行了28次评估。在第3阶段（2010年10月至2012年1月），对13名住院医师进行了44次评估。第1阶段和第2阶段之间的总分显著提高（p = 0.003），并且在整个第3阶段保持在较高水平。按能力分析表现时，除了“沟通和职业素养”（p = 0.56）外，所有能力（患者护理、知识、基于系统的实践、基于实践的学习）在第1阶段和第2阶段之间均有显著改善（p < 0.05）。除了“医学知识”持续显著改善（p = 0.003）外，在第2阶段和第3阶段之间所有能力的得分在统计学上相似。
利用来自实时、基于能力的评估工具的数据进行有针对性的住院医师反馈会议，使我们能够在30个月的时间里提高住院医师领导创伤复苏的能力。鉴于在工作时间限制内最大化临床教育机会的压力，这样的模式可能有助于减少对成本高昂的基于模拟的培训的需求。
治疗性研究，III级。
