Dobson Joseph V, Brancati David S, Nagel Rollin
a Medical University of South Carolina Charleston , SC.
b St. Vincent Mercy Medical Center Toledo , Ohio.
Med Educ Online. 2003 Dec;8(1):4337. doi: 10.3402/meo.v8i.4337.
To assess the impact of a 6-hour pediatric resuscitation curriculum on the comfort levels of resident physicians' evaluation and treatment of critically ill pediatric patients.
An evaluation instrument assessed resident comfort levels, measured on a seven digit Likert scale ranging from significantly uncomfortable to significantly comfortable, in 13 areas of pediatric resuscitation. To complete the curriculum, residents had to demonstrate proficiency in knowledge and procedural skills during mock resuscitation scenarios and on both written and oral examinations.
Thirty-one residents participated in the study: 51.6% were pediatric, 12.9% were medicine/pediatric and 35.5% were emergency medicine residents. Participants in the curriculum had little previous experience with pediatric resuscitation (83% had been involved in five or fewer pediatric resuscitations). In all 13 areas of pediatric resuscitation tested, residents reported improvement in comfort levels following the course (p<0.002; Wilcoxon Signed Rank Tests). The most significant changes were observed for the following items: resuscitation of pulseless arrest, performance of cardioversion and defibrillation, performance of intraosseous needle insertion, and drug selection and dosing for rapid sequence intubation. Fewer than 48% of learners rated themselves as comfortable in these areas prior to training, but after completion, more than 80% rated themselves in the comfortable range. All residents but one received passing scores on their written examinations (97%). During the mock resuscitation scenarios and oral examination, 100% of the residents were assessed to have 'completely' met the learning objectives and critical actions Conclusion: Implementation of a pediatric resuscitation curriculum improves pediatric and emergency medicine residents' comfort with the evaluation and treatment of critically ill pediatric patients. This curriculum can be used in residency training to document the acquisition of core competencies, knowledge and procedural skills needed for the evaluation and treatment of the critically ill child. The results reported in this study support using this model of instructional design to implement educational strategies, which will meet the requirements of graduate education.
评估为期6小时的儿科复苏课程对住院医师评估和治疗危重症儿科患者时舒适度的影响。
使用一种评估工具，在儿科复苏的13个领域，以从极不舒服到极舒适的七分量表来衡量住院医师的舒适度。为完成该课程，住院医师必须在模拟复苏场景以及笔试和口试中展示出知识和操作技能的熟练程度。
31名住院医师参与了该研究：51.6%为儿科住院医师，12.9%为内科/儿科住院医师，35.5%为急诊医学住院医师。参与课程的人员此前几乎没有儿科复苏经验（83%参与过五次或更少的儿科复苏）。在所有测试的13个儿科复苏领域，住院医师报告称课程结束后舒适度有所提高（p<0.002；Wilcoxon符号秩检验）。在以下项目中观察到最显著的变化：无脉性心脏骤停的复苏、心脏复律和除颤操作、骨内针穿刺操作以及快速顺序插管的药物选择和剂量。培训前，不到48%的学习者在这些领域给自己的舒适度评级为舒适，但课程结束后，超过80%的学习者将自己的舒适度评级为舒适范围。除一人外，所有住院医师笔试均通过（97%）。在模拟复苏场景和口试中，100%的住院医师被评估为“完全”达到学习目标和关键操作。结论：实施儿科复苏课程可提高儿科和急诊医学住院医师评估和治疗危重症儿科患者时的舒适度。该课程可用于住院医师培训，以记录评估和治疗危重症儿童所需的核心能力、知识和操作技能的掌握情况。本研究报告的结果支持使用这种教学设计模型来实施教育策略，以满足研究生教育的要求。
