Davidson Laura J, Chow Kimberly Y, Jivan Arif, Prenner Stuart B, Cohen Elaine R, Schimmel Daniel R, McGaghie William C, Barsuk Jeffrey H, Wayne Diane B, Sweis Ranya N
Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Catheter Cardiovasc Interv. 2021 Feb 15;97(3):503-508. doi: 10.1002/ccd.29128. Epub 2020 Jun 30.
Medical procedures are traditionally taught informally at patients' bedside through observation and practice using the adage "see one, do one, teach one." This lack of formalized training can cause trainees to be unprepared to perform procedures independently. Simulation based education (SBE) increases competence, reduces complications, and decreases costs. We developed, implemented, and evaluated the efficacy of a right heart catheterization (RHC) SBE curriculum.
The RHC curriculum consisted of a pretest, video didactics, deliberate practice, and a posttest. Pre-and posttest skills examinations consisted of a dichotomous 43-item checklist on RHC skills and a 14-item hemodynamic waveform quiz. We enrolled two groups of fellows: 6 first-year, novice cardiology fellows at Northwestern University in their first month of training, and 11 second- and third-year fellows who had completed traditional required, level I training in RHC. We trained the first-year fellows at the beginning of the 2018-2019 year using the SBE curriculum and compared them to the traditionally-trained cardiology fellows who did not complete SBE.
The SBE-trained fellows significantly improved RHC skills, hemodynamic knowledge, and confidence from pre- to posttesting. SBE-trained fellows performed similarly to traditionally-trained fellows on simulated RHC skills checklists (88.4% correct vs. 89.2%, p = .84), hemodynamic quizzes (94.0% correct vs. 86.4%, p = .12), and confidence (79.4 vs. 85.9 out of 100, p = .15) despite less clinical experience.
A SBE curriculum for RHC allowed novice cardiology fellows to achieve level I skills and knowledge at the beginning of fellowship and can train cardiology fellows before patient contact.
传统上，医学操作是在患者床边通过观察和实践以“看一个，做一个，教一个”的格言进行非正式教学的。这种缺乏正规培训的情况可能导致受训人员没有准备好独立进行操作。基于模拟的教育（SBE）可提高能力、减少并发症并降低成本。我们开发、实施并评估了一项右心导管插入术（RHC）SBE课程的效果。
RHC课程包括预测试、视频教学、刻意练习和后测试。预测试和后测试技能考试包括一份关于RHC技能的43项二分制清单和一份14项血流动力学波形测验。我们招募了两组研究员：6名西北大学第一年的新手心脏病学研究员，处于培训的第一个月；以及11名已完成传统要求的RHC一级培训的二、三年级研究员。我们在2018 - 2019学年开始时使用SBE课程培训第一年的研究员，并将他们与未完成SBE的传统培训的心脏病学研究员进行比较。
接受SBE培训的研究员在测试前到测试后，RHC技能、血流动力学知识和信心都有显著提高。尽管临床经验较少，但在模拟RHC技能清单（正确88.4%对89.2%，p = 0.84）、血流动力学测验（正确94.0%对86.4%，p = 0.12）和信心（100分制中79.4对85.9分，p = 0.15）方面，接受SBE培训的研究员与传统培训的研究员表现相似。
一项针对RHC的SBE课程使新手心脏病学研究员在研究员培训开始时就能达到一级技能和知识水平，并且可以在接触患者之前培训心脏病学研究员。
