Division of Pulmonary Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, MN.
Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN.
Chest. 2020 Nov;158(5):2047-2057. doi: 10.1016/j.chest.2020.04.060. Epub 2020 May 16.
Faculty supervision of invasive bedside procedures (IBPs) in the ICU may enhance procedural education and ensure patient safety. However, there is limited research on teaching effectiveness in the ICU, and there are no best teaching practices regarding the supervision of IBPs.
We conducted a multi-institutional qualitative study of pulmonary and critical care medicine faculty and fellows to better understand characteristics of effective IBP teachers.
Separate focus groups (FGs) were conducted with fellows and faculty at four large academic institutions that were geographically distributed across the United States. FGs were facilitated by a trained investigator, audio-recorded, and transcribed verbatim for analysis. Themes were identified inductively and compared with constructs from social and situated learning theories. Data were analyzed between and across professional groups. Qualitative research software (NVivo; QSR International) was used to facilitate data organization and create an audit trail of the analysis. A multidisciplinary research team was engaged to minimize interpretive bias.
Thirty-three faculty and 30 fellows participated. Inductive analysis revealed three categories of themes among successful IBP teachers: traits, behaviors, and context. Traits included calm demeanor, trust, procedural competence, and effective communication. Behaviors included leading preprocedure huddles to assess learners' experiences and define expectations; debriefing to provide feedback; and allowing appropriate autonomy. Context included learning climate, levels of distraction, patient acuity, and institutional culture.
We identified specific traits and behaviors of effective IBP teachers that intersect with the practice environment, which highlights the challenge of teaching IBPs. Notably, FG participants emphasized interpersonal, more than technical, aspects of successful IBP teachers. These findings should inform future curricula on teaching IBPs in the ICU, standardize IBP teaching for pulmonary and critical care medicine fellows, and reduce patient injury from procedural complications.
在重症监护病房（ICU）中，教师对侵入性床边操作（IBP）的监督可以加强程序教育并确保患者安全。然而，关于 ICU 教学效果的研究有限，并且在监督 IBP 方面也没有最佳的教学实践。
我们对肺科和重症监护医学的教师和研究员进行了一项多机构的定性研究，以更好地了解有效的 IBP 教师的特征。
在分布在美国各地的四个大型学术机构中，分别对研究员和教师进行了焦点小组（FG）。由一名经过培训的研究人员促进了 FG 的进行，对其进行了录音，并逐字转录进行分析。主题是通过归纳法确定的，并与社会和情境学习理论的结构进行了比较。在专业群体之间和之内对数据进行了分析。使用定性研究软件（NVivo；QSR International）来促进数据组织并创建分析的审核跟踪。一个多学科研究团队参与其中，以最大程度地减少解释偏差。
共有 33 名教师和 30 名研究员参加了研究。归纳分析显示，成功的 IBP 教师中有三个主题类别：特质、行为和背景。特质包括沉着的举止、信任、程序能力和有效的沟通。行为包括领导术前小组讨论以评估学习者的经验并定义期望；进行事后讨论以提供反馈；并允许适当的自主权。背景包括学习氛围、分心程度、患者的病情严重程度和机构文化。
我们确定了有效的 IBP 教师的具体特质和行为，这些特质和行为与实践环境相交，这凸显了教授 IBP 的挑战。值得注意的是，FG 参与者强调了成功的 IBP 教师的人际交往方面，而不是技术方面。这些发现应该为 ICU 中教授 IBP 的未来课程提供信息，为肺科和重症监护医学研究员的 IBP 教学标准化，并减少因程序并发症导致的患者伤害。
