Rábago J L, López-Doueil M, Sancho R, Hernández-Pinto P, Neira N, Capa E, Larraz E, Redondo-Figuero C G, Maestre J M
Hospital virtual Valdecilla, Santander, España; Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Valdecilla, Santander, España.
Hospital virtual Valdecilla, Santander, España; Instituto de Investigación Sanitaria Valdecilla, Santander, España.
Rev Esp Anestesiol Reanim. 2017 Oct;64(8):431-440. doi: 10.1016/j.redar.2016.12.008. Epub 2017 Mar 25.
An increased number of errors and reduced patient safety have been reported during the incorporation of residents, as this period involves learning new skills. The objectives were to evaluate the learning outcomes of an immersive simulation boot-camp for incoming residents before starting the clinical rotations. Airway assessment, airway control with direct laryngoscopy, and epidural catheterization competencies were evaluated.
Twelve first-year anaesthesiology residents participated. A prospective study to evaluate transfer of endotracheal intubation skills learned at the simulation centre to clinical practice (primary outcome) was conducted. A checklist of 28 skills and behaviours was used to assess the first supervised intubation performed during anaesthesia induction in ASA I/II patients. Secondary outcome was self-efficacy to perform epidural catheterization. A satisfaction survey was also performed.
Seventy-five percent of residents completed more than 21 out of 28 skills and behaviours to assess and control the airway during their first intubation in patients. Twelve items were performed by all residents and 5 by half of them. More than 83% of participants reported a high level of self-efficacy in placing an epidural catheter. All participants would recommend the course to their colleagues.
A focused intensive simulation-based boot-camp addressing key competencies required to begin anaesthesia residency was well received, and led to transfer of airway management skills learned to clinical settings when performing for first time on patients, and to increased self-reported efficacy in performing epidural catheterization.
据报道，在住院医师融入工作期间，错误数量增加且患者安全性降低，因为这一时期涉及学习新技能。目的是在开始临床轮转之前，评估针对新入职住院医师的沉浸式模拟培训营的学习成果。对气道评估、直接喉镜气道控制和硬膜外导管置入能力进行了评估。
12名一年级麻醉科住院医师参与。开展了一项前瞻性研究，以评估在模拟中心学到的气管插管技能向临床实践的转化情况（主要结果）。使用一份包含28项技能和行为的清单，评估在ASA I/II级患者麻醉诱导期间首次进行的有监督的插管操作。次要结果是进行硬膜外导管置入的自我效能感。还进行了满意度调查。
75%的住院医师在首次为患者插管时，完成了28项评估和控制气道的技能及行为中的21项以上。所有住院医师都完成了12项，半数住院医师完成了5项。超过83%的参与者表示在放置硬膜外导管方面有较高的自我效能感。所有参与者都会向同事推荐该课程。
一个针对麻醉住院医师入职所需关键能力的集中强化模拟培训营受到好评，在首次为患者进行操作时，能将所学的气道管理技能转化到临床环境中，并提高自我报告的硬膜外导管置入效能。
