Takeuchi Shinya, Shiga Takashi, Koyama Yasuaki, Nakanishi Taizo, Honma Yosuke, Morita Hiroshi, Goto Tadahiro
Department of Emergency Medicine, Teikyo University, Itabashi, Japan.
Department of Emergency and Critical Care Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan.
PLoS One. 2017 Nov 14;12(11):e0188224. doi: 10.1371/journal.pone.0188224. eCollection 2017.
Little is known about the acquisition of intubation skills among novice physicians during their one-year clinical training. Our primary objective was to determine the changes in the intubation skills of novice physicians between prior to the clinical training and after completion of the clinical training. We used data of a prospective longitudinal multicenter data registry developed to investigate factors associated with the improvement of intubation skills among novice physicians. The study participants included 90 postgraduate year 1 physicians in 2015-2016. We used 4 simulation scenarios based on the devices used (direct laryngoscope [DL] and Airway scope [AWS]) and difficulty of intubation (normal and difficult scenarios). As a marker of the intubation skills, we used the force applied on the maxillary incisors and the tongue with each intubation. We compared the data obtained prior to clinical training with those obtained after completion of one-year clinical training. When using DL, compared to prior, significantly less force were applied on the maxillary incisors and the tongue after clinical training in the normal scenario (28.0 N vs 19.5 N, p < 0.001, and 11.1 N vs 8.4 N, p = 0.004). Likewise, when using AWS, compared to prior, significantly less force were applied on the tongue after clinical training in the normal scenario (22.0 N vs 0 N, p < 0.001). The force on the tongue decreased after clinical training but not significant. These associations persisted in the difficult airway scenario. These findings suggest that force applied on oral structures can be quantified as a marker of intubation skills by using high-fidelity simulators, and the assessment of procedural competency is recommended for all novice physicians prior to performing intubation in the clinical setting to improve the quality of emergency care.
关于新手医生在为期一年的临床培训期间获得插管技能的情况，我们所知甚少。我们的主要目标是确定新手医生在临床培训前和临床培训完成后的插管技能变化。我们使用了一个前瞻性纵向多中心数据登记处的数据，该登记处旨在调查与新手医生插管技能提高相关的因素。研究参与者包括2015 - 2016年的90名第一年住院医师。我们根据使用的设备（直接喉镜[DL]和气道镜[AWS]）以及插管难度（正常和困难场景）使用了4种模拟场景。作为插管技能的一个指标，我们使用每次插管时对上颌切牙和舌头施加的力。我们将临床培训前获得的数据与完成一年临床培训后获得的数据进行了比较。使用DL时，在正常场景下，与临床培训前相比，临床培训后对上颌切牙和舌头施加的力显著减小（28.0牛 vs 19.5牛，p < 0.001，以及11.1牛 vs 8.4牛，p = 0.004）。同样，使用AWS时，在正常场景下，与临床培训前相比，临床培训后对舌头施加的力显著减小（22.0牛 vs 0牛，p < 0.001）。临床培训后舌头所受的力有所下降，但不显著。在困难气道场景中，这些关联依然存在。这些发现表明，通过使用高保真模拟器，施加在口腔结构上的力可以被量化为插管技能的一个指标，并且建议在临床环境中进行插管之前，对所有新手医生进行操作能力评估，以提高急诊护理质量。
