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采用混合式模拟医学教育方法早期获取非技术技能。

Early acquisition of non-technical skills using a blended approach to simulation-based medical education.

作者信息

Coggins Andrew, Desai Mihir, Nguyen Khanh, Moore Nathan

机构信息

1Emergency Department, Westmead Hospital, Hawkesbury Road, Sydney, NSW 2145 Australia.

Simulated Environment for Clinical Training (SiLECT), Sydney, Australia.

出版信息

Adv Simul (Lond). 2017 Aug 14;2:12. doi: 10.1186/s41077-017-0045-2. eCollection 2017.

Abstract

BACKGROUND

Non-technical skills are emerging as an important component of postgraduate medical education. Between 2013 and 2016, a new blended training program incorporating non-technical skills was introduced at an Australian university affiliated hospital. Program participants were medical officers in years 1 and 2 of postgraduate training.

METHODS

An interdisciplinary faculty trained in simulation-based education led the program. The blended approach combined open access online resources with multiple opportunities to participate in simulation-based learning. The aim of the study was to examine the value of the program to the participants and the effects on the wider hospital system. The mixed methods evaluation included data from simulation centre records, hospital quality improvement data, and a post-hoc reflective survey of the enrolled participants ( = 68).

RESULTS

Over 30 months, 283 junior doctors were invited to participate in the program. Enrolment in a designated simulation-based course was completed by 169 doctors (59.7%). Supplementary revision sessions were made available to the cohort with a median weekly attendance of five participants. 56/68 (82.4%) of survey respondents reported increased confidence in managing deteriorating patients. During the period of implementation, the overall rate of hospital cardiac arrests declined by 42.3%. Future objectives requested by participants included training in graded assertiveness and neurological emergencies.

CONCLUSIONS

Implementation of a non-technical skills program was achieved with limited simulation resources and was associated with observable improvements in clinical performance. The participants surveyed reported increased confidence in managing deteriorating patients, and the program introduction coincided with a significant reduction in the rate of in-hospital cardiac arrests.

摘要

背景

非技术技能正逐渐成为研究生医学教育的重要组成部分。2013年至2016年期间,澳大利亚一所大学附属医院引入了一项新的融合非技术技能的混合培训项目。项目参与者为研究生培训第1年和第2年的医务人员。

方法

由接受过基于模拟教育培训的跨学科教员领导该项目。混合式方法将开放获取的在线资源与多次参与基于模拟学习的机会相结合。该研究的目的是检验该项目对参与者的价值以及对更广泛医院系统的影响。混合方法评估包括来自模拟中心记录、医院质量改进数据以及对登记参与者(n = 68)的事后反思性调查的数据。

结果

在30多个月的时间里,283名初级医生被邀请参加该项目。169名医生(59.7%)完成了指定的基于模拟的课程注册。为该队列提供了补充复习课程,每周参加人数中位数为5人。56/68(82.4%)的调查受访者表示在管理病情恶化患者方面信心增强。在实施期间,医院心脏骤停的总体发生率下降了42.3%。参与者提出的未来目标包括分级自信训练和神经科急症培训。

结论

在有限模拟资源的情况下实现了非技术技能项目的实施,并且与临床绩效的明显改善相关。接受调查的参与者表示在管理病情恶化患者方面信心增强,并且该项目的引入与医院心脏骤停发生率的显著降低同时发生。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e79a/5806380/4d258ae1a526/41077_2017_45_Fig1_HTML.jpg

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