Interdepartmental Division of Critical Care Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
Institute for Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada.
Respir Care. 2021 Aug;66(8):1299-1305. doi: 10.4187/respcare.08793. Epub 2021 Apr 20.
Learning bronchoscopy is challenging for novices, as it requires navigation in a 3-dimensional space under 2-dimensional viewing conditions and execution of complex motor skills with an unfamiliar instrument. Mental practice exercises are based on repeated visualization of motor actions without physically performing them, thereby promoting the learning of skills. We aimed to evaluate whether a teaching intervention including mental practice exercise modules for the acquisition of bronchoscopy skills improves fiberoptic intubation performance of novice learners.
In this prospective cohort study, 24 pediatric intensive care trainees and respiratory therapists participating in a bronchoscopy learning curriculum in 2016-2017 attended a theoretical lecture followed by self-guided learning. Subsequently, the learners were randomly assigned to either participating in a teaching intervention including mental practice exercises or not (control group). The primary outcome was time to complete their first bronchoscopic intubation using a virtual reality simulator. Secondary outcomes were the occurrence of "red outs" (ie, the anatomy could no longer be visualized) or collisions with the airway wall. Bayesian Poisson Mixture models were used to estimate the effect of the intervention on outcomes. Furthermore, participation in the teaching intervention was examined in short interviews and with descriptive thematic analysis.
Subjects in the intervention group completed the bronchoscopy on average 1.2 times faster (rate ratio 1.2 [95% credible intervals 1.1-1.3]). The posterior probability that the teaching intervention reduced the occurrence of "red outs" by more than half was 86%. No differences were found regarding the odds of colliding with the airway wall. Everyone except 1 trainee in the mental practice group engaged with and found the mental practice modules helpful.
A teaching intervention including mental practice exercises represents a valuable additional learning strategy promoting the performance and complex skill acquisition of novice learners in the initial stages of learning bronchoscopy procedures.
对于新手来说，学习支气管镜检查具有挑战性，因为它需要在二维观察条件下在三维空间中进行导航，并使用不熟悉的仪器执行复杂的运动技能。心理练习是基于对运动动作的反复可视化而无需实际执行，从而促进技能的学习。我们旨在评估包括支气管镜技能获取心理练习模块的教学干预是否可以提高新手学习者的纤维光学插管性能。
在这项前瞻性队列研究中，2016-2017 年参加支气管镜学习课程的 24 名儿科重症监护培训生和呼吸治疗师参加了理论讲座，然后进行了自学。随后，学习者被随机分配到是否参加包括心理练习的教学干预组或对照组。主要结果是使用虚拟现实模拟器完成第一次支气管镜检查的时间。次要结果是发生“红色溢出”（即无法再可视化解剖结构）或与气道壁碰撞。贝叶斯泊松混合模型用于估计干预对结果的影响。此外，通过简短访谈和描述性主题分析检查了参与教学干预的情况。
干预组的受试者平均完成支气管镜检查快 1.2 倍（比率比 1.2[95%可信区间 1.1-1.3]）。干预将“红色溢出”发生率降低一半以上的后验概率为 86%。与碰撞气道壁的几率没有差异。心理练习组中除 1 名培训生外，所有人都参与并发现心理练习模块很有帮助。
包括心理练习在内的教学干预是一种有价值的附加学习策略，可以促进新手学习者在支气管镜检查程序的初始阶段的表现和复杂技能的获取。
