一项针对儿科住院医师的视频增强高级气道课程的随机对照试验。

A Randomized Controlled Trial of a Video-Enhanced Advanced Airway Curriculum for Pediatric Residents.

机构信息

K.A. Miller is a fellow, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts. M.C. Monuteaux is senior epidemiologist and biostatistician, Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts. S. Aftab is director, Fetal Care Center, Nicklaus Children's Hospital, Miami, Florida. A. Lynn is a medical student, Midwestern University Arizona College of Osteopathic Medicine, Glendale, Arizona. D. Hillier is staff physician, Intermediate Care Program, Boston Children's Hospital, Boston, Massachusetts. J. Nagler is associate physician, Division of Emergency Medicine, and director, Pediatric Emergency Medicine Fellowship, Boston Children's Hospital, Boston, Massachusetts.

出版信息

Acad Med. 2018 Dec;93(12):1858-1864. doi: 10.1097/ACM.0000000000002392.

DOI:10.1097/ACM.0000000000002392

PMID:30095451

Abstract

PURPOSE

Pediatric advanced airway management is a low-frequency but critical procedure, making it challenging for trainees to learn. This study examined the impact of a curriculum integrating prerecorded videos of patient endotracheal intubations on performance related to simulated pediatric intubation.

METHOD

The authors conducted a randomized controlled educational trial for pediatric residents between January 2015 and June 2016 at Boston Children's Hospital. Investigators collecting data were blinded to the intervention. The control group received a standard didactic curriculum including still images, followed by simulation on airway trainers. The intervention group received a video-enhanced didactic curriculum including deidentified intubation clips recorded using a videolaryngoscope, followed by simulation. The study assessed intubation skills on simulated infant and pediatric airway scenarios of varying difficulty immediately after instruction and at three months.

RESULTS

Forty-nine trainees completed the curriculum: 23 received the video-enhanced curriculum and 26 received the standard curriculum. Median time to successful intubation was 18.5 and 22 seconds in the video-enhanced and standard groups, respectively. Controlling for mannequin age and difficulty, residents receiving the video-enhanced curriculum successfully intubated faster (hazard ratio [95% confidence interval]: 1.65 [1.25, 2.19]). Video-enhanced curriculum participants also demonstrated decreased odds of requiring multiple attempts and of esophageal intubation. At three-month follow-up, residents who received the video-enhanced curriculum remained faster at intubation (hazard ratio [95% confidence interval]: 1.93 [1.23, 3.02]).

CONCLUSIONS

Integrating videos of patient intubations into an airway management curriculum improved participating pediatric residents' intubation performance on airway trainers with sustained improvement at three months.

摘要

目的

儿科高级气道管理是一项低频但关键的程序，使得受训者难以学习。本研究考察了整合患者经气管插管的预录视频课程对模拟小儿插管相关表现的影响。

方法

作者在 2015 年 1 月至 2016 年 6 月期间在波士顿儿童医院对儿科住院医师进行了一项随机对照教育试验。收集数据的调查人员对干预措施不知情。对照组接受标准的教学课程，包括静态图像，然后在气道训练器上进行模拟。干预组接受视频增强的教学课程，其中包括使用视频喉镜记录的匿名插管剪辑，然后进行模拟。研究评估了指导后即刻和三个月时不同难度的模拟婴儿和小儿气道场景中的插管技能。

结果

49 名受训者完成了课程：23 名接受视频增强课程，26 名接受标准课程。视频增强组和标准组成功插管的中位时间分别为 18.5 和 22 秒。控制模型年龄和难度，接受视频增强课程的住院医师插管速度更快（危险比[95%置信区间]：1.65[1.25,2.19]）。视频增强课程的参与者还显示出降低的需要多次尝试和食管插管的可能性。在三个月的随访中，接受视频增强课程的住院医师在插管方面仍然更快（危险比[95%置信区间]：1.93[1.23,3.02]）。