From the Department of Anaesthesia and Intensive Care, Rouen University Hospital, (ME, JM, JA, CD, EO, EB, TC, ALS, BD, VC); and Normandie Univ, UNIROUEN, inserm U982 (VC), Mont-Saint-Aignan, France.
Eur J Anaesthesiol. 2017 Jul;34(7):464-470. doi: 10.1097/EJA.0000000000000624.
Noise, which is omnipresent in operating rooms and ICUs, may have a negative impact not only patients but also on the concentration of and communication between clinical staff.
The present study attempted to evaluate the impact of noise on the performance of anaesthesiology residents' clinical reasoning. Changes in clinical reasoning were measured by script concordance tests (SCTs).
This was a randomised and crossover study.
Single centre at Rouen University Hospital in April 2014.
All year 1 to 4 residents enrolled in the anaesthesiology training programme were included.
Performance was assessed using a 56-item SCT. Two resident groups were formed, and each was exposed to both quiet and noisy atmospheres during SCT assessment. Group A did the first part of the assessment (28 SCT) in a quiet atmosphere and the second part (28 SCT) in a noisy atmosphere. Group B did the same in reverse order.
The primary outcome of this study was residents' performance as measured by SCT, with and without noise (mean of 100 points 95% confidence interval).
Forty-two residents were included. Residents' performance, measured by SCT, was weaker in a noisy environment than in a quiet environment [59.0 (56.0 to 62.0) vs 62.8 (60.8 to 64.9), P = 0.04]. This difference lessened as medical training advanced, as this difference in performance in noisy vs quiet environments was not observed in year 3 and 4 residents [62.9 (59.2 to 66.5) vs 64.0 (61.9 to 66.1), P = 0.60], whereas it was higher for year 1 and 2 residents [54.8 (50.6 to 59.1) vs 61.5 (57.9 to 65.1), P = 0.02].
Our study suggests that noise affects clinical reasoning of anaesthesiology residents especially junior residents when measured by SCT. This observation supports the hypothesis that noise should be prevented in operating rooms especially when junior residents are providing care.
噪声在手术室和 ICU 中无处不在，它不仅会对患者产生负面影响，还会影响临床医务人员的注意力和沟通。
本研究试图评估噪声对麻醉科住院医师临床推理能力的影响。通过脚本一致性测试（SCT）来衡量临床推理的变化。
这是一项随机交叉研究。
2014 年 4 月在鲁昂大学医院进行。
所有参加麻醉培训计划的 1 至 4 年级住院医师均纳入研究。
使用 56 项 SCT 评估表现。将两组住院医师分为两组，在 SCT 评估期间，每组分别暴露于安静和嘈杂的环境中。组 A 先进行第一部分评估（28 项 SCT），在安静的环境中进行，然后在嘈杂的环境中进行第二部分评估（28 项 SCT）。组 B 以相反的顺序进行。
本研究的主要结局是 SCT 评估的住院医师的表现，有无噪声（100 分的平均值，95%置信区间）。
共纳入 42 名住院医师。SCT 评估显示，在嘈杂环境中，住院医师的表现比在安静环境中更差[59.0（56.0 至 62.0）比 62.8（60.8 至 64.9），P=0.04]。这种差异随着医学培训的进展而减轻，因为在 3 年级和 4 年级住院医师中，在嘈杂环境和安静环境中的表现差异不明显[62.9（59.2 至 66.5）比 64.0（61.9 至 66.1），P=0.60]，而 1 年级和 2 年级住院医师的差异更大[54.8（50.6 至 59.1）比 61.5（57.9 至 65.1），P=0.02]。
我们的研究表明，噪声通过 SCT 影响麻醉科住院医师的临床推理能力，尤其是初级住院医师。这一观察结果支持了这样一种假设，即在手术室中应防止噪声，尤其是在初级住院医师提供护理时。
Zotero 插件