University of Washington Burn Center, Harborview Medical Center, 325 Ninth Ave, Seattle, WA, 98104, USA.
Oregon Burn Center, Legacy Emmanuel Hospital, 3001 N Gantenbein Ave, Portland, OR 97227, USA.
Injury. 2020 Sep;51(9):2059-2065. doi: 10.1016/j.injury.2020.06.007. Epub 2020 Jun 10.
Escharotomy is the primary effective intervention to relieve constriction and impending vascular compromise in deep, circumferential or near-circumferential burns of the extremities and trunk. Training on escharotomy indications, technique and pitfalls is essential, as escharotomy is both an infrequent and high-risk procedure in civilian and military medical environments, including low-resource settings. Therefore, we aimed to validate an educational strategy that combines video-based instruction with a low-cost, low-fidelity simulation model for teaching burn escharotomy.
Pre-hospital and hospital-based medical personnel, with varying degrees of burn care-related experience, participated in a one-hour training session. The first part of the training consisted of video-based instruction that described the indications, preparation, steps, pitfalls and complications associated with escharotomy. The second part of the training consisted of a supervised, hands-on simulation with a previously described low-cost, low-fidelity escharotomy model. Participants were then offered two psychometrically validated instruments to assess their learning experience.
40 participants were grouped according to prior burn care and surgical experience: attending surgeons (6), surgery and emergency medicine residents and fellows (26), medical students (5), and pre-hospital personnel (3). On two psychometrically validated questionnaires, participants at both the attending and trainee levels overwhelmingly confirmed that our educational strategy met best educational practices on the criteria of active learning, collaboration, diverse ways of learning, and high expectations; they also highly rated their satisfaction with and self-confidence under this learning strategy.
An educational strategy that combines video-based instruction and a low-cost, low-fidelity escharotomy simulation model was successfully demonstrated with participants across a broad range of prior burn care experience levels. This strategy is easily reproducible and broadly applicable to increase the knowledge and confidence of medical personnel before they are called to perform escharotomy. Important applications include resource-limited environments and deployed military settings.
切开减张术是缓解四肢和躯干深度、环形或近环形烧伤所致的紧缩和即将发生的血管损伤的主要有效干预措施。切开减张术的适应证、技术和陷阱的培训至关重要，因为切开减张术在民用和军事医疗环境中都是一种罕见且高风险的手术，包括资源有限的环境。因此，我们旨在验证一种教育策略，该策略将基于视频的指导与低成本、低保真度的模拟模型相结合，用于教授烧伤切开减张术。
具有不同程度烧伤护理相关经验的院前和医院医务人员参加了一个小时的培训课程。培训的第一部分包括基于视频的指导，介绍了切开减张术的适应证、准备、步骤、陷阱和并发症。培训的第二部分包括使用之前描述的低成本、低保真度的切开减张模型进行监督性、动手模拟。然后，参与者提供了两种经过心理测量验证的工具来评估他们的学习体验。
根据先前的烧伤护理和手术经验，将 40 名参与者分为以下几组：主治外科医生（6 人）、外科和急诊医学住院医师和研究员（26 人）、医学生（5 人）和院前人员（3 人）。在两个经过心理测量验证的问卷上，主治医生和受训者都一致认为，我们的教育策略在主动学习、协作、多样化的学习方式和高期望方面满足了最佳教育实践的标准；他们还高度评价了他们对这种学习策略的满意度和自信度。
一种将基于视频的指导与低成本、低保真度的切开减张术模拟模型相结合的教育策略，已成功应用于具有广泛先前烧伤护理经验水平的参与者。这种策略易于复制，广泛适用于提高医务人员在进行切开减张术之前的知识和信心。重要的应用包括资源有限的环境和部署的军事环境。
