From the Department of Obstetrics & Gynecology and Women's Health (M.C., J.K., E.H.B.), Montefiore Medical Center; Albert Einstein College of Medicine (M.C., H.P., J.K., E.H.B.); Department of Epidemiology and Population Health (M.J.F.), Albert Einstein College of Medicine, Bronx, NY; and Department of Obstetrics & Gynecology and Women's Health (S.P.), Stamford Hospital, CT.
Simul Healthc. 2020 Aug;15(4):289-294. doi: 10.1097/SIH.0000000000000434.
Simulation-based training to manage surgical postpartum hemorrhage allows for improved preparation for these rarely needed life-saving procedures. Our objectives were to design a low-tech simulation model for use in training and evaluation of surgical techniques for the management of postpartum hemorrhage and to present evidence of its validity in assessment and training.
Fifty-two obstetrics and gynecology residents and 25 attending physicians from an academic hospital were video recorded while performing the O'Leary and B-Lynch techniques on the low-tech model. Performance was evaluated using a Technical Skills Checklist, for B-Lynch and O'Leary techniques, and the Reznick's Global Rating Scale. Interrater reliability was computed to assess the consistency of the ratings between 2 raters. Average scores were determined and compared between incoming residents, junior residents, senior residents, and attending physicians to show construct validity.
For the B-Lynch, Technical Skills Checklist scores (maximum 17 points) of attendings (15.04) and senior residents (15.12) were higher than those of junior residents (5.63) and new residents (3.38). Global Rating Scale scores (maximum 25 points) on the B-Lynch reflected the same increase (22.38, 19.35 vs. 8.85, 6.75, respectively). For the O'Leary stitch, the scores of attendings, senior, junior, and incoming residents were as follows: 15.20, 13.65, 11.54, and 2.83, respectively (maximum 19 points). This supports the construct validity of the model. The model was considered realistic and useful for improving surgical skills in 71.4% of participants.
This low-cost, easily constructed model is a useful tool for training these surgical skills.
基于模拟的培训可以帮助管理产后出血的外科手术，从而为这些罕见的救命手术做好更充分的准备。我们的目标是设计一种用于培训和评估产后出血管理外科技术的低成本模拟模型，并提供其在评估和培训中的有效性的证据。
来自一家学术医院的 52 名妇产科住院医师和 25 名主治医生在该低成本模型上进行了 O'Leary 和 B-Lynch 技术的视频记录。使用技术技能检查表（针对 B-Lynch 和 O'Leary 技术）和 Reznick 的全球评分量表来评估表现。计算了两个评分者之间的组内相关系数，以评估评分的一致性。通过比较住院医师、初级住院医师、高级住院医师和主治医生的平均分数，展示结构有效性。
对于 B-Lynch，主治医生（15.04 分）和高级住院医师（15.12 分）的技术技能检查表（最高 17 分）得分高于初级住院医师（5.63 分）和新住院医师（3.38 分）。B-Lynch 的全球评分量表（最高 25 分）也反映了相同的增加（分别为 22.38 分和 19.35 分）。对于 O'Leary 缝线，主治医生、高级、初级和新住院医师的得分分别为：15.20 分、13.65 分、11.54 分和 2.83 分（最高 19 分）。这支持了该模型的结构有效性。71.4%的参与者认为该模型逼真且有助于提高手术技能。
这种低成本、易于构建的模型是培训这些外科技能的有用工具。
