Miller Christina, Jackson Eric, Lee Benjamin, Gottschalk Allan, Schiavi Adam
J Educ Perioper Med. 2020 Oct 1;22(4):E653. doi: 10.46374/volxxii-issue4-schiavi. eCollection 2020 Oct-Dec.
Novice anesthesiology residents must acquire new technical, cognitive, and behavioral skills as they transition into the high-stakes perioperative environment. Simulation-based education improves procedural skill and behavior, and it permits deliberate practice with feedback; exposure to uncommon, high-consequence events; assessment; reproducibility; and zero risk to patients. We introduced a 5-day, high-fidelity Simulation Boot Camp (SBC) in 2006 for first-year clinical anesthesia residents (CA-1s) and report over a decade of experience assessing its impact on self-efficacy, value, feasibility, and sustainability.
All CA-1s in our residency program participated in the SBC as part of orientation. Participants completed 2 individual high-fidelity simulations per day, each with a private debriefing session from an attending anesthesiologist in our simulation center. We measured their self-reported confidence, which we report as self-efficacy (SE), the belief in one's own ability to successfully execute a skill or behavior necessary for a desired outcome, for 25 basic anesthesia skills before and after course completion. Participants also completed a postcourse evaluation.
Of the 281 CA-1s who participated in the course from 2006 to 2016, we collected data on 267 (95%). SE improved over the course of SBC for all 25 individual skills ( < .001) and remained stable over the decade-long period of study. Univariate analysis revealed a strong association between increased SE and male sex ( < .001), video gaming experience ( < .001), and completion of a prior residency ( = .018). Males were also more likely to report video gaming experience ( < .001). Multivariable analysis revealed that although women had lower SE than did men, they had a greater increase in SE attributed to participation in SBC ( = .041). Participants strongly agreed SBC was a realistic and nonjudgmental learning tool, built confidence, and should be mandatory. Most comments were positive, reflecting overall satisfaction with SBC.
SBC increases SE, is feasible, valuable to participants, and sustainable with remarkably consistency over the study period.
新手麻醉住院医师在过渡到高风险的围手术期环境时，必须掌握新的技术、认知和行为技能。基于模拟的教育可提高操作技能和行为，并允许在有反馈的情况下进行刻意练习；接触罕见的、高后果事件；进行评估；具备可重复性；且对患者零风险。2006年，我们为一年级临床麻醉住院医师（CA-1）引入了为期5天的高保真模拟训练营（SBC），并报告了十多年来评估其对自我效能感、价值、可行性和可持续性影响的经验。
我们住院医师培训项目中的所有CA-1都参加了SBC作为入职培训的一部分。参与者每天完成2次个人高保真模拟，每次模拟后在我们的模拟中心与一位麻醉主治医师进行单独的总结汇报。我们测量了他们自我报告的信心，在课程结束前后，我们将其报告为自我效能感（SE），即相信自己有能力成功执行实现期望结果所需的技能或行为，涉及25项基本麻醉技能。参与者还完成了课程后的评估。
在2006年至2016年参加该课程的281名CA-1中，我们收集了267名（95%）的数据。在SBC课程期间，所有25项个人技能的SE均有所提高（P < .001），并且在长达十年的研究期间保持稳定。单因素分析显示，SE增加与男性性别（P < .001）、电子游戏经验（P < .001）和之前完成住院医师培训（P = .018）之间存在强关联。男性也更有可能报告有电子游戏经验（P < .001）。多变量分析显示，虽然女性的SE低于男性，但由于参加SBC，她们的SE增加幅度更大（P = .041）。参与者强烈同意SBC是一个现实且无评判性的学习工具，能增强信心，且应该是强制性的。大多数评论都是积极的，反映出对SBC的总体满意度。
SBC可提高SE，是可行的，对参与者有价值，并且在研究期间具有显著的一致性和可持续性。
