Butler Bennet A, Lawton Cort D, Burgess Jamie, Balderama Earvin S, Barsness Katherine A, Sarwark John F
Department of Orthopedic Surgery, Northwestern Memorial Hospital, Chicago, Illinois.
Division of Orthopedic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois.
J Bone Joint Surg Am. 2017 Dec 6;99(23):e128. doi: 10.2106/JBJS.17.00425.
Simulation-based education has been integrated into many orthopaedic residency programs to augment traditional teaching models. Here we describe the development and implementation of a combined didactic and simulation-based course for teaching medical students and interns how to properly perform a closed reduction and percutaneous pinning of a pediatric supracondylar humeral fracture.
Subjects included in the study were either orthopaedic surgery interns or subinterns at our institution. Subjects all completed a combined didactic and simulation-based course on pediatric supracondylar humeral fractures. The first part of this course was an electronic (e)-learning module that the subjects could complete at home in approximately 40 minutes. The second part of the course was a 20-minute simulation-based skills learning session completed in the simulation center. Subject knowledge of closed reduction and percutaneous pinning of supracondylar humeral fractures was tested using a 30-question, multiple-choice, written test. Surgical skills were tested in the operating room or in a simulated operating room. Subject pre-intervention and post-intervention scores were compared to determine if and how much they had improved.
A total of 21 subjects were tested. These subjects significantly improved their scores on both the written, multiple-choice test and skills test after completing the combined didactic and simulation module. Prior to the module, intern and subintern multiple-choice test scores were significantly worse than postgraduate year (PGY)-2 to PGY-5 resident scores (p < 0.01); after completion of the module, there was no significant difference in the multiple-choice test scores. After completing the module, there was no significant difference in skills test scores between interns and PGY-2 to PGY-5 residents. Both tests were validated using the scores obtained from PGY-2 to PGY-5 residents.
Our combined didactic and simulation course significantly improved intern and subintern understanding of supracondylar humeral fractures and their ability to perform a closed reduction and percutaneous pinning of these fractures.
基于模拟的教育已被纳入许多骨科住院医师培训项目，以增强传统教学模式。在此，我们描述了一个结合理论教学和模拟教学的课程的开发与实施，该课程用于教授医学生和实习生如何正确进行小儿肱骨髁上骨折的闭合复位和经皮穿针固定。
本研究纳入的受试者为我院骨科手术实习生或实习医生。所有受试者均完成了一门关于小儿肱骨髁上骨折的理论与模拟相结合的课程。该课程的第一部分是一个电子学习模块，受试者可在家中约40分钟内完成。课程的第二部分是在模拟中心进行的20分钟基于模拟的技能学习课程。使用一份包含30道选择题的书面测试来检验受试者对肱骨髁上骨折闭合复位和经皮穿针固定的知识掌握情况。手术技能在手术室或模拟手术室进行测试。比较受试者干预前和干预后的分数，以确定他们是否有所提高以及提高了多少。
共有21名受试者接受测试。这些受试者在完成理论与模拟相结合的模块后，在书面选择题测试和技能测试中的分数均有显著提高。在该模块之前，实习生和实习医生的选择题测试分数显著低于研究生二年级（PGY）至研究生五年级住院医师的分数（p < 0.01）；完成该模块后，选择题测试分数没有显著差异。完成该模块后，实习生与PGY - 2至PGY - 5住院医师在技能测试分数上没有显著差异。两项测试均使用从PGY - 2至PGY - 5住院医师获得的分数进行了验证。
我们的理论与模拟相结合的课程显著提高了实习生和实习医生对肱骨髁上骨折的理解以及他们进行这些骨折闭合复位和经皮穿针固定的能力。
