Espey Eve, Baty Gillian, Rask John, Chungtuyco Michelle, Pereda Brenda, Leeman Lawrence
Department of Obstetrics and Gynecology, University of New Mexico, Albuquerque, NM.
Department of Emergency Medicine, University of New Mexico, Albuquerque, NM.
Am J Obstet Gynecol. 2017 Dec;217(6):699.e1-699.e13. doi: 10.1016/j.ajog.2017.09.008. Epub 2017 Sep 14.
Emergency response skills are essential when events such as seizure, anaphylaxis, or hemorrhage occur in the outpatient setting. As services and procedures increasingly move outside the hospital, training to manage complications may improve outcomes.
The objective of this study was to evaluate a simulation-based curriculum in outpatient emergency management skills with the outcome measures of graded objective performance and learner self-efficacy.
This pre- and postcurriculum study enrolled residents and fellows in Obstetrics and Gynecology and Family Medicine in a simulation-based, outpatient emergency management curriculum. Learners completed self-efficacy questionnaires and were videotaped managing 3 medical emergency scenarios (seizure, over-sedation/cardiopulmonary arrest, and hemorrhage) in the simulation laboratory both before and after completion of the curriculum. Evaluators who were blinded to training level scored the simulation performance videotapes using a graded rubric with critical action checklists. Scenario scores were assigned in 5 domains and globally. Paired t-tests were used to determine differences pre- and postcurriculum.
Thirty residents completed the curriculum and pre- and postcurriculum testing. Subjects' objective performance scores improved in all 5 domains (P<.05) in all scenarios. When scores were stratified by level of training, all participants demonstrated global improvement. When scores were stratified by previous outpatient simulation experience, subjects with previous experience improved in all but management of excess sedation. Pre- and postcurriculum self-efficacy evaluations demonstrated improvement in all 7 measured areas: confidence, use of appropriate resources, communication skills, complex airway management, bag mask ventilation, resuscitation, and hemorrhage management. Self-efficacy assessment showed improvement in confidence managing outpatient emergencies (P=.001) and ability to communicate well in emergency situations (P<.001).
A simulation-based curriculum improved both self-efficacy and objectively rated performance scores in management of outpatient medical emergencies. Simulation-based curricula should be incorporated into residency education.
在门诊环境中发生癫痫发作、过敏反应或出血等事件时，应急响应技能至关重要。随着服务和程序越来越多地在医院外开展，应对并发症的培训可能会改善治疗结果。
本研究的目的是评估基于模拟的门诊应急管理技能课程，并以分级客观表现和学习者自我效能感作为结果指标。
这项课程前后对照研究招募了妇产科和家庭医学专业的住院医师和研究员，参与基于模拟的门诊应急管理课程。学习者完成自我效能感问卷，并在课程开始前和结束后在模拟实验室中对3种医疗紧急情况（癫痫发作、镇静过度/心肺骤停和出血）进行处理时进行录像。对培训水平不知情的评估人员使用带有关键行动清单的分级评分标准对模拟表现录像进行评分。情景得分在5个领域和整体上进行评定。采用配对t检验来确定课程前后的差异。
30名住院医师完成了课程及课程前后测试。在所有情景的所有5个领域中，受试者的客观表现得分均有所提高（P<0.05）。当按培训水平分层评分时，所有参与者均有整体提高。当按以前的门诊模拟经验分层评分时，有过相关经验的受试者除过度镇静管理外，在其他方面均有提高。课程前后的自我效能感评估显示，在所有7个测量领域均有改善：信心、适当资源的使用、沟通技能、复杂气道管理、面罩通气、复苏和出血管理。自我效能感评估显示，在管理门诊急诊方面的信心有所提高（P=0.001），在紧急情况下良好沟通的能力也有所提高（P<0.001）。
基于模拟的课程提高了门诊医疗紧急情况管理中的自我效能感和客观评定的表现得分。基于模拟的课程应纳入住院医师教育。
