Wendling Alexander, Vopat Matthew, Patel Om, Wool Nathan, Davis Nancy, Dart Bradley
University of Kansas School of Medicine-Wichita, Department of Orthopaedic Surgery.
University of Kansas School of Medicine-Wichita, Department of Family and Community Medicine.
Kans J Med. 2020 Feb 28;13:29-37. eCollection 2020.
The initial treatment for many orthopaedic injuries is splinting. Unfortunately, formal musculoskeletal training is limited in primary care leading to deficiencies in competency and confidence. Suboptimal splints can result in complications such as skin break-down, worsening of deformity, and increased pain. Our orthopaedic surgery clinic often cares for patients who initially present to an emergency department or primary care clinic for their orthopaedic injury. Previous studies have shown that a high number of splints are applied improperly in the primary care setting, which could result in in avoidable skin complications and fracture instability.
Orthopaedic surgery residents held a splinting workshop for family medicine residents. The workshop involved didactic and skills portions. Pre- and post-surveys were administered using a 10-point scale to assess confidence in applying three common splints. The data were analyzed using student's t-test and qualitative feed-back.
Confidence in applying and molding each splint type improved significantly (p < 0.05). Knowledge in splint construction improved significantly as well (p < 0.05). Subjective feedback was positive.
These results showed inter-residency education can increase residents' confidence in skill-based medical care significantly. The results are encouraging and should facilitate further collaboration between multispecialty residency programs to improve patient care. Further investigation is needed to determine how well skills gained in workshop are retained.
许多骨科损伤的初始治疗方法是使用夹板固定。不幸的是，初级保健中正规的肌肉骨骼培训有限，导致能力和信心不足。不合适的夹板可能会导致诸如皮肤破损、畸形加重和疼痛加剧等并发症。我们的骨科手术诊所经常诊治那些最初因骨科损伤而到急诊科或初级保健诊所就诊的患者。先前的研究表明，在初级保健环境中，大量夹板的应用不当，这可能会导致不可避免的皮肤并发症和骨折不稳定。
骨科住院医师为家庭医学住院医师举办了一次夹板固定工作坊。该工作坊包括理论教学和技能部分。使用10分制进行课前和课后调查，以评估应用三种常见夹板的信心。使用学生t检验和定性反馈对数据进行分析。
应用和塑形每种夹板类型的信心显著提高（p < 0.05）。夹板制作方面的知识也显著提高（p < 0.05）。主观反馈是积极的。
这些结果表明住院医师之间的教育可以显著提高住院医师对基于技能的医疗护理的信心。结果令人鼓舞，应促进多专业住院医师培训项目之间的进一步合作，以改善患者护理。需要进一步调查以确定在工作坊中获得的技能能保持多久。
