基于模拟的对年轻医生处理危重病患者的培训有助于向临床实践的过渡：一项访谈研究。
Simulation-based training of junior doctors in handling critically ill patients facilitates the transition to clinical practice: an interview study.
机构信息
Copenhagen Academy for Medical Education and Simulation, Herlev Hospital, Capital Region of Denmark and Copenhagen University, Herlev Ringvej 75, 2730 Herlev, Copenhagen, Denmark.
Department of Intensive Care 4131, Copenhagen University Hospital Rigshospitalet, Inge Lehmanns Vej 5, 2100 Copenhagen, Denmark.
出版信息
BMC Med Educ. 2019 Jan 8;19(1):11. doi: 10.1186/s12909-018-1447-0.
BACKGROUND
Junior doctors lack confidence and competence in handling the critically ill patient including diagnostic skills, decision-making and team working with other health care professionals. Simulation-based training on managing emergency situations can have substantial effects on satisfaction and learning. However, there are indications of problems when applying learned skills to practice. Our aim was to identify first-year doctors' perceptions, reflections and experiences on transfer of skills to a clinical setting after simulation-based training in handling critically ill patients.
METHODS
We used a qualitative approach and conducted semi-structured telephone interviews with a sample of twenty first-year doctors six months after a 4-day simulation-based training course in handling critically ill patients. Interviews were transcribed verbatim. A content-analysis approach was used to analyse the data.
RESULTS
The following main themes were identified from the interviews: preparedness for clinical practice, organisational readiness, use of algorithms, communication, teamwork, situational awareness and decision making. The doctors gave several examples of simulation-based training increasing their preparedness for clinical practice and handling the critically ill patient. The usefulness of algorithms and the appreciation of non-technical skills were highlighted and found to be helpful in managing clinical difficulties. Concern was expressed related to staff willingness and preparedness in using these tools.
CONCLUSIONS
Overall, the simulation-based training seemed to facilitate the transition from being a medical student to become a junior doctor. The doctors experienced an ability to transfer the use of algorithms and non-technical skills trained in the simulated environment to the clinical environment. However, the application of these skills was more difficult if these skills were unfamiliar to the surrounding clinical staff.
TRIAL REGISTRATION
Not applicable.
背景
住院医师在处理危重病患者方面缺乏信心和能力，包括诊断技能、决策能力以及与其他医疗保健专业人员的团队合作能力。基于模拟的紧急情况处理培训对满意度和学习效果有显著影响。然而，在将所学技能应用于实践中时，存在一些问题的迹象。我们的目的是确定住院医师在模拟培训处理危重病患者后，将技能转移到临床环境中的看法、反思和经验。
方法
我们采用定性方法，在模拟培训处理危重病患者 4 天后的 6 个月内，对 20 名住院医师进行了半结构式电话访谈。访谈内容逐字记录。采用内容分析方法对数据进行分析。
结果
从访谈中确定了以下主要主题：为临床实践做准备、组织准备、使用算法、沟通、团队合作、情境意识和决策。医生们举了一些模拟培训增加他们为临床实践和处理危重病患者做好准备的例子。强调了算法的有用性和对非技术技能的欣赏，并发现这些在管理临床困难时很有帮助。对员工使用这些工具的意愿和准备情况表示关注。
结论
总体而言，基于模拟的培训似乎有助于从医学生过渡到住院医师。医生们能够将模拟环境中培训的算法和非技术技能应用于临床环境。然而，如果周围临床工作人员不熟悉这些技能，那么应用这些技能就更加困难。
试验注册
不适用。
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