Spooner Michael T, Delorey Donald, Miller Kyle E, Greer Joy A
Cardiology, Naval Medical Center Portsmouth, Portsmouth, USA.
Psychology, Naval Medical Center Portsmouth, Portsmouth, USA.
Cureus. 2021 Feb 10;13(2):e13269. doi: 10.7759/cureus.13269.
Simulation has been used in medicine to train clinicians to manage a variety of clinical scenarios. A key adaptation of the use of simulation in military healthcare occurred in 2015 with the development of the STOMP (Simulation Training for Operational Medical Providers) curriculum, a specific curriculum designed for the intern (PGY-1) trained physicians being sent into the military to practice primary care. Despite showing the curriculum's influence on self-perceived comfort scores, no study has determined whether simulation is an effective means of improving general medical officer (GMO) physicians' skills compared to other traditional styles of education. Specifically, this study sought to determine whether simulation-based education (SBE) of ophthalmologic skills improves GMO physicians' clinical performance, as compared to traditional didactic-based instruction.
The study, conducted at Naval Medical Center Portsmouth, included GMO physicians who were enrolled in the 2019 STOMP class. Following a brief overview of the study, GMO physicians who elected to participate in the study were randomized to either SBE or lecture-based training for three commonly used ophthalmological procedures: slit lamp exam, tonometry, and corneal foreign body removal. After completing the simulation and lecture-based education training sessions, participants' procedural performance was evaluated utilizing a locally developed performance checklist, and completion time for each of the three procedures was recorded. Data were analyzed using the t-test and Mann-Whitney test. A significance level of 0.05 was considered to be statistically significant.
Of the 50 consented participants, 46 completed the study. The mean overall completion scores for the performance checklists were significantly higher for the SBE group (n=26) compared to the lecture group (n=20) [80% (95% CI 78-82%) vs 41% (95% CI 35-47%), respectively]. Time to completion of the individual tasks was also significantly shorter for the SBE group compared to the lecture group (with mean differences ranging from 27 to 126 seconds, all p<.05).
Simulation-based training appeared to be more effective at teaching three ophthalmological procedures (slit lamp exam, tonometry, and corneal foreign body removal) to GMO physicians compared to didactic-based instruction alone.
模拟技术已在医学领域用于培训临床医生应对各种临床场景。2015年，随着STOMP（作战医疗提供者模拟训练）课程的开发，军事医疗保健中模拟技术的使用出现了一项关键变革，这是一门专门为派往军队从事初级保健工作的实习医生（PGY - 1）设计的课程。尽管有研究表明该课程对自我感知的舒适度评分有影响，但尚无研究确定与其他传统教育方式相比，模拟是否是提高普通军医（GMO）医生技能的有效手段。具体而言，本研究旨在确定与传统的基于讲授的教学相比，基于模拟的眼科技能教育（SBE）是否能提高GMO医生的临床表现。
该研究在朴茨茅斯海军医疗中心进行，纳入了参加2019年STOMP课程的GMO医生。在对研究进行简要概述后，选择参与研究的GMO医生被随机分为SBE组或基于讲座的培训组，接受三种常用眼科手术的培训：裂隙灯检查、眼压测量和角膜异物取出术。在完成模拟和基于讲座的教育培训课程后，使用本地开发的操作检查表评估参与者的操作表现，并记录三种手术各自的完成时间。使用t检验和曼 - 惠特尼检验分析数据。显著性水平设定为0.05，被认为具有统计学意义。
在50名同意参与的参与者中，46人完成了研究。SBE组（n = 26）的操作检查表平均总体完成得分显著高于讲座组（n = 20）[分别为80%（95%可信区间78 - 82%）和41%（95%可信区间35 - 47%）]。与讲座组相比，SBE组完成各项任务的时间也显著更短（平均差异在27至126秒之间，所有p < 0.05）。
与单纯的基于讲授的教学相比，基于模拟的培训在向GMO医生教授三种眼科手术（裂隙灯检查、眼压测量和角膜异物取出术）方面似乎更有效。
