Department of Anesthesiology, BC Women's Hospital, Vancouver, BC, Canada.
Department of Anesthesiology Pharmacology and Therapeutics, University of British Columbia, Vancouver, BC, Canada.
Resuscitation. 2019 May;138:284-296. doi: 10.1016/j.resuscitation.2019.03.031. Epub 2019 Mar 27.
To systematically evaluate the literature on interventions that improve skills retention following advanced structured resuscitation training programs designed for healthcare professionals.
A systematic review of MEDLINE, EMBASE, CENTRAL, CINAHL, PsycINFO, ERIC, and Scopus was performed. Only randomized controlled trials investigating skills retention following advanced structured resuscitation training programs for healthcare professionals between inception to November 21, 2018 were included. Publications that assessed only knowledge acquisition were excluded. Relevant data from included studies were extracted and study quality was critically appraised, both independently and in duplicate by multiple reviewers. The risk of bias was assessed with the Cochrane Risk of Bias tool and the Medical Education Research Study Quality Instrument (MERSQI). Due to significant clinical heterogeneity in SRT training, study designs and interventions, a qualitative synthesis was used to summarize findings.
Sixteen studies, with a combined total of 1192 participants, were included in the final analysis. The majority of studies were conducted in North America and involved trainees or novice learners. ACLS was the most extensively studied, followed by NRP, ALS, and ATLS. Skills retention at 6 months was the most commonly used primary endpoint assessed using a simulated resuscitation checklist with either an adopted or created assessment tool. Most studies demonstrated a positive impact on skills retention when an interactive intervention or simulation was used. However, merely having a high-fidelity mannequin alone for simulation was found to have minimal effect on skills retention in the absence of other changes in content delivery. Booster sessions were found to be minimally effective in reinforcing long-term skills retention; however, most studies examining this intervention had small sample sizes and were underpowered.
Simulation-based interventions, refresher courses and adjustments to the content delivery of advanced structured resuscitation training courses were found to have the greatest impact on skills retention. However, due to significant heterogeneity and methodological flaws in the available studies, no definitive conclusions can be made regarding other interventions. Overall, there is a paucity of skills retention research and further high-quality randomized controlled trials are needed to determine the optimal intervention and design for resuscitation training that would maximize skills retention.
系统评价旨在提高为医疗保健专业人员设计的高级结构化复苏培训计划后技能保留的干预措施的文献。
对 MEDLINE、EMBASE、CENTRAL、CINAHL、PsycINFO、ERIC 和 Scopus 进行系统评价。仅纳入自成立至 2018 年 11 月 21 日期间针对医疗保健专业人员的高级结构化复苏培训计划后技能保留的随机对照试验。排除仅评估知识获取的出版物。由多名评审员独立和重复提取纳入研究的相关数据，并对研究质量进行批判性评估。使用 Cochrane 偏倚风险工具和医学教育研究质量工具（MERSQI）评估偏倚风险。由于 SRT 培训、研究设计和干预措施在临床方面存在显著异质性，因此使用定性综合来总结研究结果。
最终分析纳入了 16 项研究，共计 1192 名参与者。大多数研究在北美进行，涉及学员或新手学习者。ACLS 是研究最多的，其次是 NRP、ALS 和 ATLS。使用采用或创建评估工具的模拟复苏检查表评估 6 个月时的技能保留是最常用的主要终点。大多数研究表明，当使用交互式干预或模拟时，对技能保留有积极影响。然而，仅使用高保真人体模型进行模拟而不改变内容交付方式，发现对技能保留的影响很小。强化课程在强化长期技能保留方面效果甚微；然而，大多数研究这一干预措施的研究样本量较小，且效力不足。
基于模拟的干预措施、复习课程以及高级结构化复苏培训课程内容交付方式的调整被发现对技能保留的影响最大。然而，由于现有研究中存在显著的异质性和方法学缺陷，因此无法对其他干预措施得出明确的结论。总体而言，关于技能保留的研究很少，需要进一步进行高质量的随机对照试验，以确定能够最大程度提高技能保留的复苏培训的最佳干预措施和设计。
