Doumouras Aristithes G, Engels Paul T
Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
Department of Surgery, McMaster University, Hamilton, Ontario, Canada; Department of Critical Care, McMaster University, Hamilton, Ontario, Canada.
Surgery. 2017 Jul;162(1):174-181. doi: 10.1016/j.surg.2016.11.022. Epub 2016 Dec 20.
Medical error is common in crises, and the majority of observed errors are nontechnical in nature. The long-term impact of teaching crisis nontechnical skills to residents has not been evaluated. The objective of this study was to determine the effect of simulation-based teaching of crisis nontechnical skills compared to controls one year after initial teaching.
This was a prospective study using both historical controls and a before-and-after methodology to evaluate the effect of a high-fidelity simulation curriculum that used crisis resource management principles to teach nontechnical skills. Postgraduate year 2 and 3 residents were invited to take part in a prospective training course over 2 years. The primary outcome was leader performance evaluated by expert raters using the previously validated 7-point Ottawa Global Rating Scale.
Overall, 23 residents performed 30 simulations over the 2 years with the intervention group of 7 residents being assessed in both years. After adjustment, the postgraduate year 3 intervention group who received training the previous year had significantly higher overall performance scores than all postgraduate year 2 scores (1.09 95% confidence interval 0.70-1.47, P < .001) and the historical postgraduate year 3 cohort who received no prior training (1.20, 95% confidence interval 0.37-2.03, P = .005). There was no decay of skills noted over the course of the study.
Postgraduate year 3 residents who had prior training had significantly improved crisis performance compared to historical postgraduate year 3 controls and untrained postgraduate year 2 residents. There were no significant differences between the crisis performance of postgraduate year 2 residents and the untrained postgraduate year 3 controls. This confirms the beneficial effect and long-term retention after crisis nontechnical skill training.
医疗差错在危机中很常见，并且观察到的大多数差错本质上是非技术性的。向住院医师传授危机非技术技能的长期影响尚未得到评估。本研究的目的是确定在初始教学一年后，与对照组相比，基于模拟的危机非技术技能教学的效果。
这是一项前瞻性研究，采用历史对照和前后对照方法来评估使用危机资源管理原则教授非技术技能的高保真模拟课程的效果。邀请二年级和三年级住院医师参加为期两年的前瞻性培训课程。主要结局是由专家评分者使用先前验证的7分渥太华全球评分量表评估的领导者表现。
总体而言，23名住院医师在两年内进行了30次模拟，干预组的7名住院医师在两年中均接受了评估。调整后，前一年接受培训的三年级干预组住院医师的总体表现得分显著高于所有二年级住院医师的得分（1.09，95%置信区间0.70 - 1.47，P <.001）以及未接受过先前培训的历史三年级住院医师队列（1.20，95%置信区间0.37 - 2.03，P =.005）。在研究过程中未发现技能衰退。
与历史三年级对照组和未受过培训的二年级住院医师相比，先前接受过培训的三年级住院医师的危机表现有显著改善。二年级住院医师与未受过培训的三年级对照组的危机表现之间无显著差异。这证实了危机非技术技能培训的有益效果和长期保持情况。
