From the Family Medicine (F.G., K.S., I.S.), and Centre for Studies in Primary Care (K.S.), Queen's University, Kingston, ON, Canada.
Simul Healthc. 2019 Jun;14(3):157-162. doi: 10.1097/SIH.0000000000000355.
Simulation is an effective method for teaching acute care skills but has not been comprehensively evaluated with family medicine (FM) residents. We developed a comprehensive simulation-based approach for teaching acute care skills to FM residents and assessed it for effectiveness.
We compared the effectiveness of our standard acute care simulation training [Acute Care Rounds (ACR)] to a more comprehensive simulation-based acute care program, Nightmares-Family Medicine (NM). We used a self-reported comfort scale as well as video-captured performance on an acute care Objective Structured Clinical Examination (OSCE). Seventy-seven of our FM residents in their postgraduate year 1 between July 2012 and June 2015 participated in the study. Wilcoxon matched pairs and one-tailed t tests analysis was used for analyzing the comfort scale, Whitney-Mann, and χ for the OSCE performance.
Nightmares-Family Medicine's initial 2-day session significantly improved the resident's self-assessment scores on all 20 items of the questionnaire (P < 0.05). Time-matched ACR improved 11 of 20 items (P < 0.05) level. Follow-up NM sessions improved 5 to 8 of 20 items (P < 0.05). Follow-up ACR sessions improved 1 to 5 of 20 items (P < 0.05). The means taken at the end of postgraduate year 1 year were higher for 13 of 20 items in the NM group (P < 0.05) as compared with ACR group. The NM group scored significantly higher on both the mean scores of OSCE individual categories (P < 0.01) and the Global Assessment Score (P < 0.05). Significantly less NM residents failed the OSCE (n = 1/30, 3.3% vs n = 8/37, 21.6%, P < 0.05).
"Nightmares-Family Medicine" course is very effective at teaching acute care skills to FM residents and more so than our previous curriculum.
模拟是教授急症护理技能的有效方法，但尚未对家庭医学（FM）住院医师进行全面评估。我们为 FM 住院医师开发了一种综合的基于模拟的急症护理技能培训方法，并评估了其效果。
我们比较了我们标准的急性护理模拟培训[急性护理轮（ACR）]与更全面的基于模拟的急性护理计划“噩梦-家庭医学（NM）”的效果。我们使用自我报告的舒适度量表以及在急性护理客观结构化临床考试（OSCE）上的视频捕获表现来进行评估。2012 年 7 月至 2015 年 6 月期间，我们的 77 名 FM 住院医师在他们的研究生一年级参加了这项研究。使用 Wilcoxon 配对和单侧 t 检验分析舒适度量表，使用 Whitney-Mann 和 χ 分析 OSCE 表现。
“噩梦-家庭医学”的初始 2 天课程显著提高了居民对问卷中 20 个项目的自我评估分数（P < 0.05）。时间匹配的 ACR 改善了 20 个项目中的 11 个（P < 0.05）。随后的 NM 课程改善了 5 至 8 个项目（P < 0.05）。随后的 ACR 课程改善了 1 至 5 个项目（P < 0.05）。在研究生一年级结束时，NM 组的 20 个项目中有 13 个的平均值更高（P < 0.05），而 ACR 组则为 20 个项目中的 13 个。NM 组在 OSCE 各个类别（P < 0.01）和总体评估分数（P < 0.05）的平均得分上均明显更高。NM 组的 OSCE 失败人数明显较少（n = 30，3.3%比 n = 37，21.6%，P < 0.05）。
“噩梦-家庭医学”课程非常有效地教授 FM 住院医师急症护理技能，效果优于我们之前的课程。
