基于模拟的复杂导尿场景中住院医师决策的认知评估。
A Simulation-based, cognitive assessment of resident decision making during complex urinary catheterization scenarios.
作者信息
Nathwani Jay N, Law Katherine E, Witt Anna K, Ray R D, DiMarco S M, Pugh C M
机构信息
University of Wisconsin, General Surgery, Madison, WI, USA.
University of Wisconsin, Industrial and Systems Engineering, Madison, WI, USA.
出版信息
Am J Surg. 2017 Apr;213(4):622-626. doi: 10.1016/j.amjsurg.2017.01.007. Epub 2017 Jan 7.
BACKGROUND
This study explores general surgery residents' decision making skills in uncommon, complex urinary catheter scenarios.
METHODS
40 residents were presented with two scenarios. Scenario A was a male with traumatic urethral injury and scenario B was a male with complete urinary blockage. Residents verbalized whether they would catheterize the patient and described the workup and management of suspected pathologies. Residents' decision paths were documented and analyzed.
RESULTS
In scenario A, 45% of participants chose to immediately consult Urology. 47.5% named five diagnostic tests to decide if catheterization was safe. In scenario B, 27% chose to catheterize with a 16 French Coude. When faced with catheterization failure, participants randomly upsized or downsized catheters. Chi-square analysis revealed no measurable consensus amongst participants.
CONCLUSIONS
Residents need more training in complex decision making for urinary catheterization. The decision trees generated in this study provide a useful blueprint of residents' learning needs.
SUMMARY
Exploration of general surgery residents' decision making skills in uncommon, complex urinary catheter scenarios revealed major deficiencies. The resulting decision trees reveal residents' learning needs.
背景
本研究探讨普通外科住院医师在不常见的复杂导尿情况下的决策技能。
方法
向40名住院医师展示了两种情况。情况A是一名患有创伤性尿道损伤的男性，情况B是一名患有完全性尿路梗阻的男性。住院医师说出他们是否会为患者导尿，并描述对疑似病症的检查和处理。记录并分析住院医师的决策路径。
结果
在情况A中，45%的参与者选择立即咨询泌尿外科。47.5%的人列出了五项诊断测试以确定导尿是否安全。在情况B中，27%的人选择使用16法式弯头导尿管进行导尿。当面临导尿失败时，参与者随机增大或减小导尿管尺寸。卡方分析显示参与者之间没有可衡量的共识。
结论
住院医师在复杂的导尿决策方面需要更多培训。本研究中生成的决策树为住院医师的学习需求提供了有用的蓝图。
总结
对普通外科住院医师在不常见的复杂导尿情况下的决策技能进行探索，发现了重大缺陷。由此产生的决策树揭示了住院医师的学习需求。
Zotero 插件