Itoh Taichi, Lee-Jayaram Jannet, Fang Rui, Hong Travis, Berg Benjamin
From the Department of Pediatrics, John A. Burns School of Medicine, University of Hawai'i, and Kapi'olani Medical Center for Women and Children, Honolulu, HI.
Pediatr Emerg Care. 2019 Oct;35(10):712-715. doi: 10.1097/PEC.0000000000001516.
Just-in-time training (JITT) is a method of simulation-based training where the training occurs within the clinical environment in a concise manner. Just-in-time training has shown effects at the learner, patient, and system-wide levels. We evaluated a JITT curriculum for the procedures of intraosseous (IO) needle placement and defibrillator use in a pediatric emergency department (ED) by comparing the trainees' comfort level in performing those procedures independently (Kirkpatrick level 2a) and trainees' knowledge of the procedures/equipment (Kirkpatrick level 2b) before and after the JITT.
The study enrolled all fourth year medical students and residents (family medicine and pediatrics) who rotated through a children's hospital ED. The JITT curriculum included group discussion on storage locations of procedure equipment in the ED and clinical indications/contraindications followed by hands-on procedure training. One of 2 attending physicians facilitated the 10- to 20-minute JITT in the ED during their shifts. Trainees completed an anonymous survey to delineate medical training level, previous procedure experiences, procedure-related knowledge, and comfort level to perform the procedures independently. Identical surveys were completed before and after the JITT. The data were analyzed using percentage for categorical variables. For comparisons between pre-JITT and post-JITT survey data, χ tests or Fisher exact tests were used.
There were 65 surveys included (34 pre-JITT and 31 post-JITT surveys). The comfort level to perform procedures independently increased from pre-JITT 0% to post-JITT 48% (P < 0.001) for IO needle placement and from pre-JITT 3% to post-JITT 32% (P = 0.0016) for defibrillator use. The procedure-related knowledge also increased by ##greater than or equal to 50% post-JITT (P < 0.0001).
Our JITT curriculum significantly increased the comfort level of the trainees to perform IO needle insertion and defibrillator use independently. Procedure-related knowledge also increased. By increasing their comfort to perform these procedures independently, we aim to increase the likelihood that trainees can be competent contributing members of an acute medical response team in these respective roles.
即时培训（JITT）是一种基于模拟的培训方法，培训在临床环境中以简洁的方式进行。即时培训已在学习者、患者和系统层面显示出效果。我们通过比较培训学员在接受即时培训前后独立执行这些操作的舒适度（柯克帕特里克二级a）以及对操作/设备的知识掌握情况（柯克帕特里克二级b），评估了针对儿科急诊科（ED）骨内（IO）针放置和除颤器使用操作的即时培训课程。
该研究纳入了所有在儿童医院急诊科轮转的四年级医学生和住院医师（家庭医学和儿科学专业）。即时培训课程包括关于急诊科操作设备存储位置以及临床适应症/禁忌症的小组讨论，随后是实际操作培训。两名主治医生中的一名在轮班期间在急诊科进行10至20分钟的即时培训。学员完成一份匿名调查问卷，以描述医学培训水平、既往操作经验、与操作相关的知识以及独立执行操作的舒适度。在即时培训前后完成相同的调查问卷。使用分类变量的百分比对数据进行分析。对于即时培训前和即时培训后调查数据的比较，使用χ检验或费舍尔精确检验。
共纳入65份调查问卷（即时培训前34份，即时培训后31份）。对于IO针放置，独立执行操作的舒适度从即时培训前的0%提高到即时培训后的48%（P < 0.001）；对于除颤器使用，从即时培训前的3%提高到即时培训后的32%（P = 0.0016）。与操作相关的知识在即时培训后也增加了##大于或等于50%（P < 0.0001）。
我们的即时培训课程显著提高了学员独立进行IO针插入和使用除颤器的舒适度。与操作相关的知识也有所增加。通过提高他们独立执行这些操作的舒适度，我们旨在增加学员能够胜任急性医疗反应团队中这些相应角色的可能性。
