Lemke Madeline, Banwell Alison, Rubinger Natalie, Wiepjes Michelle, Ropeleski Mark, Vanner Stephen, Hookey Lawrence
Gastrointestinal Diseases Research Unit, Queen's University, Kingston, Ontario, Canada.
J Can Assoc Gastroenterol. 2019 Nov 23;4(1):15-20. doi: 10.1093/jcag/gwz031. eCollection 2021 Feb.
Optimal colonoscopy training curricula should minimize stress and cognitive load. This study aimed to determine whether withdrawal or insertion colonoscopy skills training is associated with less stress or cognitive load for trainees or trainers.
In Phase I, participants were randomized to train on either insertion or withdrawal in a simulated environment. In Phase II, participants were randomized to begin with either insertion or withdrawal in patient encounters. Salivary cortisol levels, heart rate, and State-Trait Anxiety Inventory (STAI) surveys were used to assess stress in trainees and trainers. NASA Task Load Index (TLX) survey was used to assess cognitive workload in trainees.
In Phase I, trainee stress increased during the simulation training during both withdrawal and insertion compared to baseline, while trainer stress changed minimally. Cognitive load was higher for trainees during withdrawal ( = 0.005). In Phase II, trainers' STAI scores were greater during insertion training ( = 0.013). Trainees' stress was highest prior to beginning patient training and decreased during training, while trainer's stress increased during training. Trainees reported insertion training being of greater value (70.0%), while trainers reported withdrawal was preferred (77.8%).
Trainees and trainers exhibit important differences in stress during colonoscopy skills training. Trainees reported more stress during simulation training and greatest cognitive load during simulation withdrawal, whereas trainers reported greatest stress during patient encounters, particularly training of insertion techniques. Attention to the effect of stress on trainees and trainers and the drivers of stress is warranted and could be incorporated in competency based medical education.
最佳结肠镜检查培训课程应尽量减少压力和认知负荷。本研究旨在确定结肠镜插入或退出技能培训是否与学员或培训师的压力减轻或认知负荷降低相关。
在第一阶段，参与者被随机分配在模拟环境中进行插入或退出操作的培训。在第二阶段，参与者在患者诊疗过程中被随机分配从插入或退出操作开始。使用唾液皮质醇水平、心率和状态-特质焦虑量表（STAI）调查来评估学员和培训师的压力。使用美国国家航空航天局任务负荷指数（TLX）调查来评估学员的认知工作量。
在第一阶段，与基线相比，学员在模拟培训期间插入和退出操作时的压力均增加，而培训师的压力变化最小。学员在退出操作时的认知负荷更高（P = 0.005）。在第二阶段，培训师在插入培训期间的STAI评分更高（P = 0.013）。学员在开始患者培训前压力最高，培训期间压力降低，而培训师的压力在培训期间增加。学员报告插入培训更有价值（70.0%），而培训师报告更喜欢退出操作培训（77.8%）。
学员和培训师在结肠镜检查技能培训期间的压力表现出重要差异。学员在模拟培训期间报告压力更大，在模拟退出操作时认知负荷最大，而培训师在患者诊疗过程中，特别是插入技术培训时报告压力最大。有必要关注压力对学员和培训师的影响以及压力的驱动因素，并可将其纳入基于胜任力的医学教育中。
