From the *Department of Anesthesiology and Pain Medicine, University of Ottawa, Ottawa, Ontario, Canada; †Department of Anesthesia and Pain Medicine, Dammam University, Dammam, Saudi Arabia; ‡Knowledge Translation Program, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto; §Epidemiology Division, Dalla Lana School of Public Health, University of Toronto, Toronto; ∥Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital; and **Department of Innovation in Medical Education, University of Ottawa, Ottawa, Ontario, Canada.
Reg Anesth Pain Med. 2017 Nov/Dec;42(6):741-750. doi: 10.1097/AAP.0000000000000639.
Ultrasound-guided regional anesthesia (UGRA) has become the criterion standard of regional anesthesia practice. Ultrasound-guided regional anesthesia teaching programs often use simulation, and guidelines have been published to help guide URGA education. This systematic review aimed to examine the effectiveness of simulation-based education for the acquisition and maintenance of competence in UGRA.
Studies identified in MEDLINE, EMBASE, CINAHL, Cochrane Central Register of Controlled Trials, and ERIC were included if they assessed simulation-based UGRA teaching with outcomes measured at Kirkpatrick level 2 (knowledge and skills), 3 (transfer of learning to the workplace), or 4 (patient outcomes). Two authors independently reviewed all identified references for eligibility, abstracted data, and appraised quality.
After screening 176 citations and 45 full-text articles, 12 studies were included. Simulation-enhanced training improved knowledge acquisition (Kirkpatrick level 2) when compared with nonsimulation training. Seven studies measuring skill acquisition (Kirkpatrick level 2) found that simulation-enhanced UGRA training was significantly more effective than alternative teaching methods or no intervention. One study measuring transfer of learning into the clinical setting (Kirkpatrick level 3) found no difference between simulation-enhanced UGRA training and non-simulation-based training. However, this study was discontinued early because of technical challenges. Two studies examined patient outcomes (Kirkpatrick level 4), and one of these found that simulation-based UGRA training improved patient outcomes compared with didactic teaching.
Ultrasound-guided regional anesthesia knowledge and skills significantly improved with simulation training. The acquired UGRA skills may be transferred to the clinical setting; however, further studies are required to confirm these changes translate to improved patient outcomes.
超声引导区域麻醉（UGRA）已成为区域麻醉实践的标准。超声引导区域麻醉教学计划通常使用模拟，并且已经发布了指南来帮助指导 URGA 教育。本系统评价旨在检查基于模拟的教育在获取和维持 UGRA 能力方面的有效性。
如果评估了基于模拟的 UGRA 教学，并以柯克帕特里克 2 级（知识和技能）、3 级（学习向工作场所的转移）或 4 级（患者结果）的结果进行测量，则纳入在 MEDLINE、EMBASE、CINAHL、Cochrane 中央对照试验注册库和 ERIC 中确定的研究。两位作者独立审查了所有合格的参考文献、提取数据并评估了质量。
在筛选了 176 条引文和 45 篇全文文章后，纳入了 12 项研究。与非模拟培训相比，模拟增强培训可提高知识获取（柯克帕特里克 2 级）。七项研究测量技能获取（柯克帕特里克 2 级）发现，模拟增强的 UGRA 培训明显优于替代教学方法或无干预。一项研究测量学习向临床环境的转移（柯克帕特里克 3 级）发现，模拟增强的 UGRA 培训与非基于模拟的培训之间没有差异。然而，由于技术挑战，这项研究提前终止。两项研究检查了患者结果（柯克帕特里克 4 级），其中一项发现，基于模拟的 UGRA 培训与教学相比，改善了患者的结果。
超声引导区域麻醉的知识和技能通过模拟培训显著提高。获得的 UGRA 技能可能会转移到临床环境中；然而，需要进一步的研究来确认这些变化是否转化为改善患者的结果。
