School of Medicine, National University of Ireland Galway, 1 Distillery Road, Galway, Ireland.
Irish Centre for Applied Patient Safety and Simulation, National University of Ireland Galway, Galway, Ireland.
BMC Med Educ. 2020 Mar 31;20(1):102. doi: 10.1186/s12909-020-02021-8.
SAFMEDS (Say-All-Fast-Minute-Every-Day-Shuffled) is a flashcard-type behavioural instructional methodology, involving one-minute learning trials that function both as practice and assessment, used to facilitate the development of fluency in a behaviour. The primary research question was whether SAFMEDS engenders improvement in performance beyond that conferred by usual teaching. A secondary research question was whether SAFMEDS is an effective method of producing fluency in Electrocardiogram (ECG) interpretation.
A pilot study was conducted to determine sample size required to power the pragmatic randomised controlled trial (RCT). For the subsequent RCT, participants were randomly assigned to a "usual teaching" control group (n = 14) or the SAFMEDS intervention group (n = 13), with the recognition of 15 cardiac conditions on ECGs (e.g., atrial fibrillation, complete heart block) targeted. Intervention group participants' performance was tracked over eight weeks as they worked towards achieving the fluency criterion. Percentage accuracy in ECG interpretation was assessed at baseline and post-test for both groups. An ANCOVA was conducted to assess for differences in the performance of the intervention and control group at post-test while controlling for the baseline performance of participants. At post-test, the numbers of participants achieving fluency within the intervention group was examined.
A large effect size of SAFMEDS (partial η = .67) was identified when controlling for the effects of baseline performance. At post-test, the intervention group significantly outperformed (M = 61.5%; SD = 12.1%) the control group (M = 31.6%; SD = 12.5%, p < .001). In total, 7 of 13 intervention group participants achieved fluency. Participants required an average of 51.9 one-minute trials (SD = 18.8) to achieve fluency.
SAFMEDS offers a useful adjunct to usual teaching within medical education. Further research could assess whether learning retains, is stable, and transfers to clinical practice.
SAFMEDS（每天快速说一切洗牌）是一种抽认卡式行为教学方法，包括一分钟学习试验，既作为练习又作为评估，用于促进行为流利度的发展。主要研究问题是 SAFMEDS 是否能提高表现，超越通常的教学效果。次要研究问题是 SAFMEDS 是否是一种产生心电图（ECG）解释流利度的有效方法。
进行了一项试点研究，以确定进行实用随机对照试验（RCT）所需的样本量。对于随后的 RCT，参与者被随机分配到“常规教学”对照组（n=14）或 SAFMEDS 干预组（n=13），目标是识别心电图上的 15 种心脏状况（例如，心房颤动，完全性心脏阻滞）。干预组参与者在八周内努力达到流利标准时，其表现被跟踪。对两组基线和后测时的心电图解释准确率进行评估。进行 ANCOVA 以评估在控制参与者基线表现的情况下，干预组和对照组在后测时的表现差异。在后测时，检查干预组内达到流利程度的参与者人数。
当控制基线表现的影响时，SAFMEDS 的效果大小很大（部分η=.67）。在后测时，干预组的表现明显优于对照组（M=61.5%；SD=12.1%）（M=31.6%；SD=12.5%，p<.001）。在总共 13 名干预组参与者中，有 7 人达到了流利程度。参与者平均需要 51.9 个一分钟试验（SD=18.8）才能达到流利程度。
SAFMEDS 为医学教育中的常规教学提供了有用的辅助手段。进一步的研究可以评估学习是否保留、稳定，并转移到临床实践中。
