肯尼亚的一项即时超声检查试点培训项目。
A pilot training program for point-of-care ultrasound in Kenya.
作者信息
Bell Greg, Wachira Benjamin, Denning Gerene
机构信息
Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, USA.
Emergency Department, University of Iowa Hospitals and Clinics, Iowa City 52242, Iowa, USA.
出版信息
Afr J Emerg Med. 2016 Sep;6(3):132-137. doi: 10.1016/j.afjem.2016.03.002. Epub 2016 Apr 6.
INTRODUCTION
Ultrasound is an effective and affordable clinical diagnostic tool highly attractive for use in low and middle income countries (LMICs), but access to training programs in these countries is limited. The objective of our study was to develop and pilot a program for healthcare providers in Kenya in the use of point-of-care ultrasound.
METHODS
Trainees were recruited in district hospitals for participation in three all-day workshops held every 3-5 months from September 2013 through November 2014. Prior to the initial workshop, trainees were asked to study a training manual, and a knowledge test was administered. Ultrasound-credentialed emergency physicians provided brief didactic lessons then hands-on training for eFAST and obstetric training. This was followed by an observed assessment of scanning image quality (IM) and diagnostic interpretation (IN).
RESULTS
Eighty-one trainees enrolled in four initial training sessions and 30 attended at least one refresher session. Among those trainees who attended refresher sessions, there was an increase in the proportion passing both the knowledge and practical tests at the follow-up, as compared to the initial session. Overall, mean practical skill scores also trended toward an increase over time, with a significantly higher mean score in November 2014 (2.64 + 0.38, = 0.02) as compared to March 2014 (2.26 + 0.54), < 0.05. Pre-workshop preparation evolved over time with the goal of maximizing trainee readiness for the hands-on course. A strong correlation was observed between knowledge and practical skill scores illustrating the importance of pre-workshop training.
CONCLUSIONS
Our pilot workshop showed promise in promoting knowledge and practical skills among participants, as well as increasing use in patient care. Results also suggest that refresher training may provide additional benefits for some participants. These findings provide a strong rationale for expanding the training program and for measuring its clinical impact.
引言
超声是一种有效且经济实惠的临床诊断工具，在低收入和中等收入国家（LMICs）极具应用吸引力，但这些国家的培训项目获取机会有限。我们研究的目的是为肯尼亚的医疗服务提供者开发并试点一项即时超声使用项目。
方法
从2013年9月至2014年11月，每3 - 5个月在地区医院招募学员参加三场为期一整天的研讨会。在初始研讨会之前，要求学员学习培训手册，并进行知识测试。具备超声资质的急诊医生先进行简短的理论授课，然后进行针对扩展聚焦评估（eFAST）和产科检查的实践培训。随后进行扫描图像质量（IM）和诊断解读（IN）的观察评估。
结果
81名学员参加了四次初始培训课程，30人至少参加了一次复习课程。在参加复习课程的学员中，与初始课程相比，后续通过知识和实践测试的比例有所增加。总体而言，平均实践技能得分也随时间呈上升趋势，2014年11月的平均得分（2.64 + 0.38，P = 0.02）显著高于2014年3月（2.26 + 0.54），P < 0.05。随着时间推移，课前准备不断改进，目标是使学员为实践课程做好充分准备。观察到知识和实践技能得分之间存在强相关性，说明课前培训的重要性。
结论
我们的试点研讨会在促进参与者的知识和实践技能以及增加在患者护理中的应用方面显示出前景。结果还表明，复习培训可能对一些参与者有额外益处。这些发现为扩大培训项目并衡量其临床影响提供了有力依据。
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