基于模拟训练中主动（热座）角色与观察者角色对压力水平和非技术表现的影响：一项随机试验。
The effects of active (hot-seat) versus observer roles during simulation-based training on stress levels and non-technical performance: a randomized trial.
作者信息
Bong Choon Looi, Lee Sumin, Ng Agnes Suah Bwee, Allen John Carson, Lim Evangeline Hua Ling, Vidyarthi Arpana
机构信息
1Department of Paediatric Anaesthesia, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore, 229899 Singapore.
2Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, 8, College Road, Singapore, 169857 Singapore.
出版信息
Adv Simul (Lond). 2017 Mar 20;2:7. doi: 10.1186/s41077-017-0040-7. eCollection 2017.
BACKGROUND
Active 'hands-on' participation in the 'hot-seat' during immersive simulation-based training (SBT) induces stress for participants, which is believed to be necessary to improve performance. We hypothesized that observers of SBT can subsequently achieve an equivalent level of non-technical performance as 'hot-seat' participants despite experiencing lower stress.
METHODS
We randomized 37 anaesthesia trainees into two groups to undergo three consecutive SBT scenarios. Eighteen 'hot-seat' trainees actively participated in all three scenarios, and 19 'observer' trainees were directed to observe the first two scenarios and participated in the 'hot-seat' only in scenario 3. Salivary cortisol (SC) was measured at four time points during each scenario. Primary endpoint for stress response was the change in SC (ΔSC) from baseline. Performance was measured using the Anaesthetist's Non-Technical Skills (ANTS) Score.
RESULTS
Mean SC increased in all participants whenever they were in the 'hot-seat' role, but not when in the observer role. Hot-seat ΔSC (mcg/dL) for scenarios 1, 2, and 3 were 0.122 ( = 0.001), 0.074 ( = 0.047), and 0.085 ( = 0.023), respectively. Observers ΔSC (mcg/dL) for scenarios 1, 2, and 3 were -0.062 ( = 0.091), 0.010 ( = 0.780), and 0.144 ( = 0.001), respectively. Mean ANTS scores were equivalent between the 'hot-seat' (40.0) and 'observer' (39.4) groups in scenario 3 ( = 0.733).
CONCLUSIONS
Observers of SBT achieved an equivalent level of non-technical performance, while experiencing lower stress than trainees repeatedly trained in the 'hot-seat'. Our findings suggest that directed observers may benefit from immersive SBT even without repeated 'hands-on' experience and stress in the hot-seat. The directed observer role may offer a less stressful, practical alternative to the traditional 'hot-seat' role, potentially rendering SBT accessible to a wider audience.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier NCT02211378, registered August 5, 2014, retrospectively registered.
背景
在基于沉浸式模拟训练（SBT）的“热座”环节中积极“亲自动手”参与会给参与者带来压力，而这种压力被认为对提高表现是必要的。我们假设，SBT的观察者尽管经历的压力较小，但随后能达到与“热座”参与者同等水平的非技术表现。
方法
我们将37名麻醉实习生随机分为两组，让他们连续进行三个SBT场景。18名“热座”实习生积极参与了所有三个场景，19名“观察者”实习生被要求观察前两个场景，仅在场景3中参与“热座”。在每个场景的四个时间点测量唾液皮质醇（SC）。压力反应的主要终点是SC相对于基线的变化（ΔSC）。使用麻醉医生非技术技能（ANTS）评分来衡量表现。
结果
所有参与者在担任“热座”角色时，其平均SC都会升高，但担任观察者角色时则不会。场景1、2和3的“热座”ΔSC（微克/分升）分别为0.122（=0.001）、0.074（=0.047）和0.085（=0.023）。场景1、2和3的观察者ΔSC（微克/分升）分别为-0.062（=0.091）、0.010（=0.780）和0.144（=0.001）。在场景3中，“热座”组（40.0）和“观察者”组（39.4）的平均ANTS评分相当（=0.733）。
结论
SBT的观察者在非技术表现上达到了同等水平，同时所经历的压力低于在“热座”中反复训练的实习生。我们的研究结果表明，定向观察者即使没有在“热座”中的反复“亲自动手”经验和压力，也可能从沉浸式SBT中受益。定向观察者角色可能为传统的“热座”角色提供一种压力较小的实用替代方案，有可能使更广泛的受众能够参与SBT。
试验注册
ClinicalTrials.gov标识符NCT02211378，于2014年8月5日注册，追溯注册。
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