From the Department of Neonatology (L.M.S.), and Center for Translational Science (L.M.S., K.R.F.), Children's Research Institute, Children's National Hospital; The George Washington University School of Medicine and Health Sciences (L.M.S., E.F.G., K.R.F.); Simulation Program (H.A.W.), Children's National Hospital; The George Washington University Graduate School of Education and Human Development (E.F.G.); and Division of General and Community Pediatrics (K.R.F.), Children's National Hospital, Washington, DC.
Simul Healthc. 2022 Feb 1;17(1):e83-e90. doi: 10.1097/SIH.0000000000000551.
Neonatal endotracheal intubation is a critical skill that is difficult for learners to acquire even with simulation-based training (SBT). Trainees prefer clinical experiences over SBT. The objective of the study was to explore the differences between SBT and clinical practice in acquiring neonatal intubation skills to inform mannequin design and to improve fidelity.
A basic qualitative study using semistructured interviews was conducted to determine the experience of newly competent trainees (second- and third-year neonatal-perinatal medicine fellows) and their instructors in developing intubation skills. Participants were asked to compare learning through SBT with clinical practice in terms of context, equipment, and environment. Their responses were analyzed using an inductive approach.
Thirty-two participants (20 fellows and 12 faculty) indicated that SBT does not equal the real experience. Specifically, the look, feel, and function of the simulators differ enough from the real patient and the clinical environmental that they do not elicit the desired learning responses. The clinical environment prompted heightened emotions and had a chaotic atmosphere that was not fully captured by SBT. Participants suggested that programs use SBT in the initial phases of training only to gain basic skills and they provided several solutions for mannequin and SBT session design.
Simulation-based training does not fully prepare neonatal-perinatal medicine fellows for neonatal intubation. Mannequins with unique active features, such as multiple airway configurations, slipperiness, secretions, and softer textures should be developed. Realistic environments that replicate the interprofessional nature and stressors of the clinical environment might better prepare learners for the complexity of clinical practice.
新生儿气管内插管是一项对学习者来说很难掌握的关键技能，即使有基于模拟的培训（SBT）也是如此。学员更喜欢临床经验而不是 SBT。本研究的目的是探讨 SBT 和临床实践在获取新生儿插管技能方面的差异，为模型设计提供信息，并提高保真度。
采用半结构化访谈的基本定性研究，以确定新胜任的学员（第二和第三年新生儿围产医学研究员）及其导师在发展插管技能方面的经验。参与者被要求从背景、设备和环境方面比较 SBT 与临床实践的学习。使用归纳法分析他们的反应。
32 名参与者（20 名研究员和 12 名教师）表示，SBT 不等同于真实体验。具体来说，模拟器的外观、感觉和功能与真实患者和临床环境有足够的差异，无法引起所需的学习反应。临床环境引发了更高的情绪，并具有混乱的氛围，这在 SBT 中无法完全捕捉到。参与者建议在培训的初始阶段仅使用 SBT 来获得基本技能，并为模型和 SBT 课程设计提供了一些解决方案。
基于模拟的培训不能为新生儿围产医学研究员完全准备新生儿插管。应开发具有独特主动功能的模型，例如多种气道配置、滑溜性、分泌物和更柔软的质地。复制临床环境的专业性和压力源的现实环境可能会更好地为学习者应对临床实践的复杂性做好准备。
