Division of Respiratory & Critical Care Medicine, University Medicine Cluster, National University Health System, Singapore; Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Department of Educational Research and Development, School of Health Professions Education, Maastricht University, Maastricht, the Netherlands.
J Crit Care. 2019 Feb;49:50-55. doi: 10.1016/j.jcrc.2018.10.009. Epub 2018 Oct 16.
Echocardiography is increasingly being taught to intensive care unit residents. Current training methods require teachers to closely supervise trainees individually, and are time-intensive. To reduce the time burden, dyad training (training in pairs) under simulation conditions has been shown to be non-inferior to individual training. We aimed to validate these preliminary results for focused subcostal echocardiography (FSE), in an authentic clinical context.
We conducted a quasi-experimental study within a 20-bed medical intensive care unit from June 2016 to March 2017. For supervised practice, residents were divided into individual versus dyad training groups. Residents then performed at least five FSE examinations, which were remotely scored by a blinded observer for image quality and correct interpretation. The main outcome measure was the mean composite image quality and interpretation score for the first five echoes done under indirect supervision (composite score range 1-8).
16 residents received individual training and 17 residents received dyad training. The mean composite score did not differ between the individual and dyad training groups (6.0 ± 0.4 versus 5.9 ± 0.4, 95% CI of difference - 0.2 to 0.4).
Assuming a 1-point non-inferiority threshold for the mean composite score, dyad training for FSE was non-inferior to individual training.
越来越多的重症监护病房（intensive care unit，ICU）住院医师开始学习超声心动图技术。目前的培训方法要求教师对学员进行一对一的密切监督，因此非常耗时。为了减少时间负担，模拟条件下的双人培训（dyad training）已被证明与单人培训一样有效。我们旨在真实临床环境下验证聚焦肋下超声心动图（focused subcostal echocardiography，FSE）的这些初步结果。
我们在 2016 年 6 月至 2017 年 3 月期间开展了一项 20 床内科重症监护病房内的准实验研究。在监督实践中，住院医师分为单人培训组和双人培训组。然后，住院医师进行了至少 5 次 FSE 检查，由一位经过盲法培训的观察者远程对图像质量和正确解读进行评分。主要结局指标为间接监督下的前 5 次 FSE 检查的平均综合图像质量和解读评分（综合评分范围 1-8 分）。
16 名住院医师接受单人培训，17 名住院医师接受双人培训。单人培训组和双人培训组的平均综合评分无差异（6.0±0.4 分比 5.9±0.4 分，95%置信区间差值为-0.2 至 0.4）。
假设平均综合评分的 1 分非劣效性阈值，FSE 的双人培训不劣于单人培训。
