Copenhagen Academy for Medical Education and Simulation, Copenhagen, The Capital Region of Denmark, Denmark.
Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
J Gen Intern Med. 2018 Feb;33(2):148-154. doi: 10.1007/s11606-017-4207-7. Epub 2017 Nov 13.
Lumbar puncture is often associated with uncertainty and limited experience on the part of residents; therefore, preparatory interventions can be essential. There is growing interest in the potential benefit of videos over written text. However, little attention has been given to whether the design of the videos impacts on subsequent performance.
To investigate the effect of different preparatory interventions on learner performance and self-confidence regarding lumbar puncture (LP).
Randomized controlled trial in which participants were randomly assigned to one of three interventions as preparation for performing lumbar puncture: 1) goal- and learner-centered video (GLV) presenting procedure-specific process goals and learner-centered information; 2) traditional video (TV) providing expert-driven content, but no process goals; and 3) written text (WT) with illustrations.
Participants were PGY-1 doctors without LP experience. After the preparatory intervention, participants performed an LP in a simulated setting with a standardized patient and an assistant. Two content experts, blinded to participant group allocation, assessed video recordings of the performance using the Lumbar Puncture Assessment Tool (LumPAT) and an overall global rating. Participants rated their self-confidence immediately prior to performing the procedure. The primary outcome was the difference in LumPAT scores among groups.
A total of 110 PGY-1 doctors were included. Results demonstrated significant differences in LumPAT mean scores among the three groups: GLV, 42.8; TV, 40.6; WT, 38.1 (p = 0.01). The global rating scores were highest in the GLV group (p = 0.026). Self-confidence scores differed significantly among the three groups (p = 0.003), with the TV group scoring the highest. There were no significant correlations between self-confidence scores and performance scores in any of the groups.
A video designed with procedure-specific process goals and learner-centered information resulted in better subsequent LP performance than a traditionally designed video or written text. Participants' self-confidence was not predictive of their actual performance.
腰椎穿刺常令住院医师感到不确定和经验有限；因此，预备干预措施可能至关重要。视频的潜在益处越来越受到关注。然而，很少有人关注视频的设计是否会影响后续的表现。
调查不同预备干预措施对腰椎穿刺（LP）学习者表现和自信心的影响。
一项随机对照试验，参与者随机分配到三种干预措施之一，作为进行腰椎穿刺的准备：1）以目标和学习者为中心的视频（GLV），呈现特定于过程的目标和以学习者为中心的信息；2）提供专家驱动内容但无过程目标的传统视频（TV）；3）带有插图的书面文本（WT）。
参与者为没有 LP 经验的 PGY-1 医生。在预备干预后，参与者在模拟环境中与标准化患者和助手一起进行 LP。两位内容专家对操作视频进行盲法评估，使用腰椎穿刺评估工具（LumPAT）和整体总体评分进行评估。参与者在进行手术前立即对自己的自信心进行评分。主要结果是组间 LumPAT 评分的差异。
共纳入 110 名 PGY-1 医生。结果表明，三组间的 LumPAT 平均得分存在显著差异：GLV 组为 42.8；TV 组为 40.6；WT 组为 38.1（p=0.01）。GLV 组的总体评分最高（p=0.026）。三组间的自信心评分差异显著（p=0.003），其中 TV 组得分最高。在任何一组中，自信心评分与表现评分之间均无显著相关性。
与传统设计的视频或书面文本相比，具有特定于过程的目标和以学习者为中心的信息的视频设计可带来更好的后续 LP 表现。参与者的自信心不能预测其实际表现。
