Greenstein Yonatan Y, Littauer Ross, Narasimhan Mangala, Mayo Paul H, Koenig Seth J
Hofstra Northwell School of Medicine, New Hyde Park, NY.
Yale School of Medicine, New Haven, CT.
Chest. 2017 Jan;151(1):34-40. doi: 10.1016/j.chest.2016.08.1465. Epub 2016 Sep 16.
Widespread use of critical care ultrasonography (CCUS) for the management of patients in the ICU requires an effective training program. The effectiveness of national and regional CCUS training courses is not known. This study describes a national-level, simulation-based, 3-day CCUS training program and evaluates its effectiveness.
Five consecutive CCUS courses, with a total of 363 people, were studied. The 3-day CCUS training program consisted of didactic lectures, ultrasonography interpretation sessions, and hands-on modules with live models. Thoracic, vascular, and abdominal ultrasonography were taught in addition to goal-directed echocardiography. Learners rotated between hands-on training and interpretation sessions. The teacher-to-learner ratio was 1:3 during hands-on training. Interpretation sessions were composed of interactive small groups that reviewed normal and abnormal ultrasonography images. Learners completed a video-based examination before and after completion of the courses. Hands-on image acquisition skills were tested at the completion of the course.
Average scores on the pretest and posttest were 57% and 90%, respectively (P < .001). The average score on the hands-on test was 86%. Learners aged 20 to 39 years compared with learners ≥ 40 years old scored better on the pretest (64% vs 51%; P < 0.001), posttest (91% vs 88%; P < .010), and hands-on test (90% vs 82%; P < .001).
Learners demonstrated a significant improvement in written test scores that assessed cognitive and image interpretation abilities. In addition, they demonstrated acquisition of practical skills as evidenced by high scores during hands-on testing. Further studies are needed to determine if a simulation-based CCUS course will translate into effective clinical practice and to measure the durability of training. This 3-day course is an effective method to train large groups of critical care clinicians in the skills requisite for CCUS (image acquisition and image interpretation).
在重症监护病房(ICU)中广泛使用重症超声(CCUS)来管理患者需要一个有效的培训项目。国家和地区性CCUS培训课程的效果尚不清楚。本研究描述了一个国家级的、基于模拟的、为期3天的CCUS培训项目,并评估其效果。
对连续举办的5期CCUS课程进行研究,共有363人参加。为期3天的CCUS培训项目包括理论讲座、超声解读课程以及使用真实模型的实践模块。除目标导向超声心动图外,还教授了胸部、血管和腹部超声。学员在实践培训和解读课程之间轮换。实践培训期间师生比例为1:3。解读课程由互动小组组成,小组会复习正常和异常的超声图像。学员在课程开始前和结束后完成基于视频的考试。课程结束时测试实践图像采集技能。
前测和后测的平均成绩分别为57%和90%(P < 0.001)。实践测试的平均成绩为86%。20至39岁的学员在前测(64%对51%;P < 0.001)、后测(91%对88%;P < 0.010)和实践测试(90%对82%;P < 0.001)中的得分均高于40岁及以上的学员。
学员在评估认知和图像解读能力的笔试成绩上有显著提高。此外,他们在实践测试中的高分证明了其获得了实践技能。需要进一步研究以确定基于模拟的CCUS课程是否能转化为有效的临床实践,并衡量培训的持续性。这个为期3天的课程是培训大批重症监护临床医生掌握CCUS所需技能(图像采集和图像解读)的有效方法。