Mejía Vilma, Gonzalez Carlos, Delfino Alejandro E, Altermatt Fernando R, Corvetto Marcia A
Universidad de Chile, Facultad de Medicina, Departamento de Educación en Ciencias de la Salud, Santiago, Chile.
Pontificia Universidad Católica de Chile, Facultad de Educación, Santiago, Chile.
Braz J Anesthesiol. 2018 May-Jun;68(3):292-298. doi: 10.1016/j.bjan.2018.01.005. Epub 2018 Apr 6.
The primary purpose of this study was to compare the effect of high fidelity simulation versus a computer-based case solving self-study, in skills acquisition about malignant hyperthermia on first year anesthesiology residents.
After institutional ethical committee approval, 31 first year anesthesiology residents were enrolled in this prospective randomized single-blinded study. Participants were randomized to either a High Fidelity Simulation Scenario or a computer-based Case Study about malignant hyperthermia. After the intervention, all subjects’ performance in was assessed through a high fidelity simulation scenario using a previously validated assessment rubric. Additionally, knowledge tests and a satisfaction survey were applied. Finally, a semi-structured interview was done to assess self-perception of reasoning process and decision-making.
28 first year residents finished successfully the study. Resident's management skill scores were globally higher in High Fidelity Simulation versus Case Study, however they were significant in 4 of the 8 performance rubric elements: recognize signs and symptoms ( = 0.025), prioritization of initial actions of management ( = 0.003), recognize complications ( = 0.025) and communication ( = 0.025). Average scores from pre- and post-test knowledge questionnaires improved from 74% to 85% in the High Fidelity Simulation group, and decreased from 78% to 75% in the Case Study group ( = 0.032). Regarding the qualitative analysis, there was no difference in factors influencing the student's process of reasoning and decision-making with both teaching strategies.
Simulation-based training with a malignant hyperthermia high-fidelity scenario was superior to computer-based case study, improving knowledge and skills in malignant hyperthermia crisis management, with a very good satisfaction level in anesthesia residents.
本研究的主要目的是比较高保真模拟与基于计算机的病例解决自学对一年级麻醉学住院医师在恶性高热技能获取方面的效果。
经机构伦理委员会批准，31名一年级麻醉学住院医师参加了这项前瞻性随机单盲研究。参与者被随机分为高保真模拟场景组或关于恶性高热的基于计算机的案例研究组。干预后，通过使用先前验证的评估量表的高保真模拟场景评估所有受试者的表现。此外，还进行了知识测试和满意度调查。最后，进行了半结构化访谈以评估推理过程和决策的自我认知。
28名一年级住院医师成功完成了研究。与案例研究相比，高保真模拟中住院医师的管理技能得分总体上更高，但在8个表现量表要素中的4个要素上具有显著性差异：识别体征和症状（P = 0.025）、管理初始行动的优先级（P = 0.003）、识别并发症（P = 0.025）和沟通（P = 0.025）。高保真模拟组的测试前和测试后知识问卷平均得分从74%提高到85%，案例研究组从78%下降到75%（P = 0.032）。关于定性分析，两种教学策略在影响学生推理和决策过程的因素方面没有差异。
基于恶性高热高保真场景的模拟训练优于基于计算机的案例研究，提高了恶性高热危机管理方面的知识和技能，麻醉住院医师的满意度很高。
