Petrosoniak Andrew, Ryzynski Agnes, Lebovic Gerald, Woolfrey Karen
From the Department of Emergency Medicine (A.P.), St. Michael's Hospital; Division of Emergency Medicine, Department of Medicine (A.P.), University of Toronto; Sunnybrook Canadian Simulation Centre (A.R.), Sunnybrook Health Sciences Centre; Applied Health Research Centre (G.L.), St. Michael's Hospital, Toronto; and Division of Emergency Medicine (K.W.), University of Western Ontario, London, Ontario, Canada.
Simul Healthc. 2017 Apr;12(2):76-82. doi: 10.1097/SIH.0000000000000206.
Technical skill acquisition for rare procedures can be challenging given the few real-life training opportunities. In situ simulation (ISS), a training technique that takes place in the actual workplace, is a promising method to promote environmental fidelity for rare procedures. This study evaluated a simulation-based technical skill curriculum for cricothyroidotomy using deliberate practice, followed by an ISS evaluation session.
Twenty emergency medicine residents participated in a two-part curriculum to improve cricothryoidotomy performance. A pretest established participant baseline technical skill. The training session consisted of two parts, didactic teaching followed by deliberate practice using a task-training manikin. A posttest consisted of an unannounced, high-fidelity ISS, during an emergency department shift. The primary outcome was the mean performance time between the pretest and posttest sessions. Skill performance was also evaluated using a checklist scale and global rating scale.
Cricothyroidotomy performance time improved significantly from pretest to posttest sessions (mean difference, 59 seconds; P < 0.0001). Both checklist and global rating scales improved significantly from the pretest to the posttest with a mean difference of 1.82 (P = 0.002) and 6.87 (P = 0.0025), respectively. Postcourse survey responses were favorable for both the overall curriculum experience and the unannounced ISS.
This pilot study demonstrated that unannounced ISS is feasible and can be used to effectively measure cricothyroidotomy performance among EM residents. After a two-part training session consisting of didactic learning and deliberate practice, improved cricothyroidotomy skill performance was observed during an unannounced ISS in the emergency department. The integration of ISS in cricothyroidotomy training represents a promising approach; however, further study is needed to establish its role.
鉴于现实生活中的培训机会较少，掌握罕见手术的技术技能具有挑战性。原位模拟（ISS）是一种在实际工作场所进行的培训技术，是提高罕见手术环境逼真度的一种有前景的方法。本研究评估了一种基于模拟的环甲膜切开术技术技能课程，该课程采用刻意练习，随后进行原位模拟评估环节。
20名急诊医学住院医师参加了一个分为两部分的课程，以提高环甲膜切开术的操作水平。预测试确定了参与者的基线技术技能。培训环节包括两部分，先是理论教学，然后使用任务训练模型进行刻意练习。后测试包括在急诊科轮班期间进行的一次不预先通知的高保真原位模拟。主要结果是预测试和后测试环节之间的平均操作时间。还使用检查表量表和整体评分量表对技能操作进行评估。
从预测试到后测试环节，环甲膜切开术的操作时间有显著改善（平均差异为59秒；P < 0.0001）。检查表量表和整体评分量表从预测试到后测试均有显著改善，平均差异分别为1.82（P = 0.002）和6.87（P = 0.0025）。课程结束后的调查反馈对整体课程体验和不预先通知的原位模拟都很有利。
这项初步研究表明，不预先通知的原位模拟是可行的，可用于有效测量急诊医学住院医师的环甲膜切开术操作水平。在由理论学习和刻意练习组成的两部分培训环节之后，在急诊科进行的一次不预先通知的原位模拟中观察到环甲膜切开术技能操作有所改善。将原位模拟纳入环甲膜切开术培训是一种有前景的方法；然而，需要进一步研究以确定其作用。
