Ambardekar Aditee P, Black Stephanie, Singh Devika, Lockman Justin L, Simpao Allan F, Schwartz Alan J, Hales Roberta L, Rodgers David L, Gurnaney Harshad G
Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, Texas.
Department of Anesthesiology and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Paediatr Anaesth. 2019 Jul;29(7):753-759. doi: 10.1111/pan.13652. Epub 2019 May 27.
Resident education in pediatric anesthesiology is challenging. Traditional curricula for anesthesiology residency programs have included a combination of didactic lectures and mentored clinical service, which can be variable. Limited pediatric medical knowledge, technical inexperience, and heightened resident anxiety further challenge patient care. We developed a pediatric anesthesia simulation-based curriculum to address crises related to hypoxemia and dysrhythmia management in the operating room as an adjunct to traditional didactic and clinical experiences.
The primary objective of this trial was to evaluate the impact of a simulation curriculum designed for anesthesiology residents on their performance during the management of crises in the pediatric operating room. A secondary objective was to compare the retention of learned knowledge by assessment at the eight-week time point during the rotation.
In this prospective, observational trial 30 residents were randomized to receive simulation-based education on four perioperative crises (Laryngospasm, Bronchospasm, Supraventricular Tachycardia (SVT), and Bradycardia) during the first week (Group A) or fifth week (Group B) of an eight-week rotation. Assessment sessions that included two scenarios (Laryngospasm, SVT) were performed in the first week, fifth week, and the eighth week of their rotation for all residents. The residents were assessed in real time and by video review using a 7-point checklist generated by a modified Delphi technique of senior pediatric anesthesiology faculty.
Residents in Group A showed improvement between the first week and fifth week assessment as well as between first week and eighth week assessments without decrement between the fifth week and eighth week assessments for both the laryngospasm and SVT scenarios. Residents in Group B showed improvement between the first week and eighth week assessments for both scenarios and between the fifth week and eighth week assessment for the SVT scenario.
This adjunctive simulation-based curriculum enhanced the learner's management of laryngospasm and SVT management and is a reasonable addition to didactic and clinical curricula for anesthesiology residents.
儿科麻醉住院医师培训具有挑战性。麻醉住院医师培训项目的传统课程包括理论讲座和带教临床服务相结合的方式，其效果可能参差不齐。儿科医学知识有限、技术经验不足以及住院医师焦虑情绪加剧，给患者护理带来了进一步挑战。我们开发了一种基于模拟的儿科麻醉课程，作为传统理论和临床经验的辅助手段，以应对手术室中与低氧血症和心律失常管理相关的危机。
本试验的主要目的是评估为麻醉住院医师设计的模拟课程对他们在儿科手术室危机管理期间表现的影响。次要目的是通过在轮转期间的八周时间点进行评估，比较所学知识的保留情况。
在这项前瞻性观察性试验中，30名住院医师被随机分为两组，在为期八周的轮转的第一周（A组）或第五周（B组）接受关于四种围手术期危机（喉痉挛、支气管痉挛、室上性心动过速（SVT）和心动过缓）的基于模拟的教育。所有住院医师在轮转的第一周、第五周和第八周进行包括两种场景（喉痉挛、SVT）的评估课程。使用由资深儿科麻醉学教员通过改良德尔菲技术生成的7分检查表对住院医师进行实时评估和视频回顾评估。
对于喉痉挛和SVT场景，A组住院医师在第一周和第五周评估之间以及第一周和第八周评估之间均有改善，在第五周和第八周评估之间没有下降。B组住院医师在两种场景的第一周和第八周评估之间以及SVT场景的第五周和第八周评估之间均有改善。
这种基于模拟的辅助课程增强了学习者对喉痉挛和SVT的管理能力，是麻醉住院医师理论和临床课程的合理补充。
