Prakash Shivesh, Bihari Shailesh, Laver Russell, Chandran Giresh, Kerr Lachlan, Schuwirth Lambert, Bersten Andrew
College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
Intensive Care, Flinders Medical Centre, Bedford Park, SA, Australia.
Crit Care Med. 2020 Sep;48(9):1265-1270. doi: 10.1097/CCM.0000000000004448.
Conventionally, simulation-based teaching involves reflection on recalled events (recall-assisted reflection). Instead of recall, video-assisted reflection may reduce recall bias and improve skills retention by contributing to visual memory. Here, we test the hypothesis that when compared with recall, video-assisted reflection results in higher acquisition and retention of skills involved in airway management among junior critical care doctors.
Randomized control trial. Participants were randomized 1:1 to video-assisted reflection or recall-assisted reflection group.
University-affiliated tertiary care center.
Junior critical care doctors.
Video-assisted reflection.
All participants underwent simulation-based teaching of technical and nontechnical airway skills involved in managing a critically ill patient. These skills were assessed before, post-workshop, and in the following fourth week, by two independent blinded assessors using a validated scoring tool. Quality of debrief was assessed using a validated questionnaire. Repeated-measures analysis of variance was used to assess time and group interaction. Forty doctors were randomized. At baseline, the groups had similar airway experience (p = 0.34) and skill scores (p = 0.97). There was a significant interaction between study groups and changes over time for total skill scores (F[2, 37] = 4.06; p = 0.02). Although both the study groups had similar and significant improvement in total skills scores at the postworkshop assessment, the decline in total skills scores at delayed assessment (F[1, 38] = 5.64; p = 0.02) was significantly more in the recall-assisted reflection group when compared with the video-assisted reflection group. This resulted in lower mean skill scores in the recall-assisted reflection group when compared with the video-assisted reflection group in the delayed assessment (89.45 [19.32] vs 110.10 [19.54]; p < 0.01). Better retention was predominantly in the nontechnical skills. The perceived quality of debrief was similar between the two groups.
When compared with recall, video-assisted reflection resulted in similar improvement in airway skills, but better retention over time.
传统上，基于模拟的教学涉及对回忆事件的反思（回忆辅助反思）。与回忆不同，视频辅助反思可能通过促进视觉记忆来减少回忆偏差并提高技能保留率。在此，我们检验以下假设：与回忆相比，视频辅助反思能使初级重症监护医生在气道管理技能的获取和保留方面表现更佳。
随机对照试验。参与者按1:1随机分为视频辅助反思组或回忆辅助反思组。
大学附属三级护理中心。
初级重症监护医生。
视频辅助反思。
所有参与者均接受了基于模拟的危重症患者气道管理技术和非技术技能教学。在工作坊前、工作坊后及随后第四周，由两名独立的盲法评估者使用经过验证的评分工具对这些技能进行评估。使用经过验证的问卷评估总结汇报的质量。采用重复测量方差分析评估时间和组间交互作用。40名医生被随机分组。在基线时，两组的气道经验（p = 0.34）和技能得分（p = 0.97）相似。研究组与总技能得分随时间变化之间存在显著交互作用（F[2, 37] = 4.06；p = 0.02）。虽然在工作坊后评估时，两组的总技能得分均有相似且显著的提高，但与视频辅助反思组相比，回忆辅助反思组在延迟评估时总技能得分的下降幅度更大（F[1, 38] = 5.64；p = 0.02）。这导致在延迟评估时，回忆辅助反思组的平均技能得分低于视频辅助反思组（89.45 [19.32] 对110.10 [19.54]；p < 0.01）。更好的保留主要体现在非技术技能方面。两组对总结汇报质量的感知相似。
与回忆相比，视频辅助反思在气道技能方面能带来相似的提高，但随着时间推移保留效果更好。
