Department of Anesthesia, Pain Management, and Perioperative Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax Infirmary Site, 1796 Summer Street, Halifax, NS, B3H 3K9, Canada.
Department of Anesthesiology and Pain Medicine, The Ottawa Hospital, Ottawa, ON, Canada.
Can J Anaesth. 2017 Dec;64(12):1182-1193. doi: 10.1007/s12630-017-0973-2. Epub 2017 Oct 6.
As simulator fidelity (i.e., realism) increases from low to high, the simulator more closely resembles the real environment, but it also becomes more expensive. It is generally assumed that the use of high-fidelity simulators results in better learning; however, the effect of fidelity on learning non-technical skills (NTS) is unknown. This was a non-inferiority trial comparing the efficacy of high- vs low-fidelity simulators on learning NTS.
Thirty-six postgraduate medical trainees were recruited for the trial. During the pre-test phase, the trainees were randomly assigned to manage a scenario using either a high-fidelity simulator (HFS) or a low-fidelity simulator (LFS), followed by expert debriefing. All trainees then underwent a video recorded post-test scenario on a HFS, and the NTS were assessed between the two groups. The primary outcome was the overall post-test Ottawa Global Rating Scale (OGRS), while controlling for overall pre-test OGRS scores. Non-inferiority between the LFS and HFS was based on a non-inferiority margin of greater than 1.
For our primary outcome, the mean (SD) post-test overall OGRS score was not significantly different between the HFS and LFS groups after controlling for pre-test overall OGRS scores [3.8 (0.9) vs 4.0 (0.9), respectively; mean difference, 0.2; 95% confidence interval, -0.4 to 0.8; P = 0.48]. For our secondary outcomes, the post-test total OGRS score was not significantly different between the HFS and LFS groups after controlling for pre-test total OGRS scores (P = 0.33). There were significant improvements in mean overall (P = 0.01) and total (P = 0.003) OGRS scores from pre-test to post-test. There were no significant associations between postgraduate year (P = 0.82) and specialty (P = 0.67) on overall OGRS performance.
This study suggests that low-fidelity simulators are non-inferior to the more costly high-fidelity simulators for teaching NTS to postgraduate medical trainees.
随着模拟器逼真度（即逼真度）从低到高的提高，模拟器越来越接近真实环境，但成本也越来越高。人们普遍认为，使用高保真度模拟器可以带来更好的学习效果；然而，逼真度对非技术技能（NTS）学习的影响尚不清楚。这是一项非劣效性试验，比较了高保真度模拟器与低保真度模拟器在学习 NTS 方面的效果。
招募了 36 名研究生医学实习生参加该试验。在预测试阶段，实习生被随机分配使用高保真度模拟器（HFS）或低保真度模拟器（LFS）来管理一个场景，然后进行专家讲解。所有实习生随后在 HFS 上进行了记录视频的后测试场景，对两组的 NTS 进行了评估。主要结果是总体后测试渥太华全球评估量表（OGRS），同时控制总体预测试 OGRS 评分。LFS 和 HFS 之间的非劣效性基于大于 1 的非劣效性边界。
对于我们的主要结果，在控制了预测试总体 OGRS 评分后，HFS 和 LFS 组之间的后测试总体 OGRS 评分没有显著差异[分别为 3.8（0.9）和 4.0（0.9）；平均差异，0.2；95%置信区间，-0.4 至 0.8；P=0.48]。对于我们的次要结果，在控制了预测试总 OGRS 评分后，HFS 和 LFS 组之间的后测试总 OGRS 评分没有显著差异（P=0.33）。从预测试到后测试，总体（P=0.01）和总（P=0.003）OGRS 评分均有显著提高。研究生年级（P=0.82）和专业（P=0.67）对 OGRS 总体表现没有显著影响。
这项研究表明，低保真度模拟器在教授研究生医学实习生非技术技能方面与成本更高的高保真度模拟器没有差异。
