División de Anestesiología, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Acta Anaesthesiol Scand. 2021 Feb;65(2):244-256. doi: 10.1111/aas.13716. Epub 2020 Oct 16.
Deconstructing a complex procedure improves skills learning, but no model has covered all relevant Percutaneous Dilatational Tracheostomy (PDT) procedural aspects. Moreover, the heterogeneity of techniques described may hinder trainees' competency acquisition. Our objective was to develop a PDT model for procedural training that includes a comprehensive step-by-step design.
Procedural descriptions were retrieved after a structured search in medical databases. Activities were extracted and the adherence to McKinley's dimensions of procedural competence was analyzed. We developed a comprehensive PDT model, which was further validated through a Delphi-based consensus of Spanish-speaking international experts.
The 14 descriptions retrieved for analysis presented a median [interquartile range] of 18 [11-22] steps, covering 3 [2-4] of McKinley's dimensions. The Delphi panel's first model included all McKinley's dimensions, and was answered by 25 experts from nine countries, ending in the second round. The final model included 59 activities divided into six stages (51 from the initial model and eight proposed by experts) and performed by two operators (bronchoscopy and tracheostomy).
We have presented a PDT model that includes necessary competence dimensions to be considered complete. The model was validated by an experts' consensus, allowing to improve procedural training to promote safer patient care.
解构复杂的程序可以提高技能学习，但没有一个模型涵盖了所有相关的经皮扩张气管切开术（PDT）程序方面。此外，所描述的技术的异质性可能会阻碍学员的能力获得。我们的目标是开发一种 PDT 程序培训模型，该模型包括全面的逐步设计。
在医学数据库中进行结构化搜索后，检索程序描述。提取活动，并分析其对 McKinley 程序能力维度的遵守情况。我们开发了一个全面的 PDT 模型，并通过西班牙语国际专家的 Delphi 共识进行了进一步验证。
为分析而检索的 14 份描述中，中位数 [四分位间距]为 18 [11-22]步，涵盖了 McKinley 的 3 [2-4]个维度。德尔菲小组的第一个模型包括了 McKinley 的所有维度，由来自九个国家的 25 名专家回答，在第二轮结束。最终模型包括 59 项活动，分为六个阶段（初始模型中的 51 项和专家提出的 8 项），由两名操作员（支气管镜和气管切开术）执行。
我们提出了一个 PDT 模型，其中包括了被认为是完整的必要能力维度。该模型通过专家共识进行了验证，这有助于改进程序培训，以促进更安全的患者护理。
