Legoux Camille, Gerein Richard, Boutis Kathy, Barrowman Nicholas, Plint Amy
Harvard Medical School Boston MA USA.
the Children's Hospital of Eastern Ontario (CHEO) University of Ottawa Ottawa Ontario Canada.
AEM Educ Train. 2020 Oct 16;5(3):e10536. doi: 10.1002/aet2.10536. eCollection 2021 Jul.
While short-term gains in performance of critical emergency procedures are demonstrated after simulation, long-term retention is relatively uncertain. Our objective was to determine whether simulation of critical emergency procedures promotes long-term retention of skills in nonsurgical physicians.
We searched multiple electronic databases using a peer-reviewed strategy. Eligible studies 1) were observational cohorts, quasi-experimental or randomized controlled trials; 2) assessed intubation, cricothyrotomy, pericardiocentesis, tube thoracostomy, or central line placement performance by nonsurgical physicians; 3) utilized any form of simulation; and 4) assessed skill performance immediately after and at ≥ 3 months after simulation. The primary outcome was skill performance at or above a preset performance benchmark at ≥ 3 months after simulation. Secondary outcomes included procedural skill performance at 3, 6, and ≥ 12 months after simulation.
We identified 1,712 citations, with 10 being eligible for inclusion. Methodologic quality was moderate with undefined primary outcomes; inadequate sample sizes; and use of nonstandardized, unvalidated tools. Three studies assessed performance to a specific performance benchmark. Two demonstrated maintenance of the minimum performance benchmark while two demonstrated significant skill decay. A significant decline in the mean performance scores from immediately after simulation to 3, 6, and ≥ 12 months after simulation was observed in four of four, three of four, and two of five studies, respectively. Scores remained significantly above baseline at 3, 6, and ≥ 12 months after simulation in three of four, three of four, and four of four studies, respectively.
There were a limited number of studies examining the retention of critical skills after simulation training. While there was some evidence of skill retention after simulation, overall most studies demonstrated skill decline over time.
虽然模拟训练后关键急救操作的短期表现有所提升，但长期记忆情况相对不确定。我们的目的是确定关键急救操作的模拟训练是否能促进非外科医生对技能的长期记忆。
我们采用同行评审策略搜索了多个电子数据库。符合条件的研究 1）为观察性队列研究、准实验或随机对照试验；2）评估非外科医生的插管、环甲膜切开术、心包穿刺术、胸腔闭式引流术或中心静脉置管操作表现；3）采用任何形式的模拟训练；4）在模拟训练后立即及≥3 个月时评估技能表现。主要结局是模拟训练后≥3 个月时达到或高于预设表现基准的技能表现。次要结局包括模拟训练后 3、6 和≥12 个月时的操作技能表现。
我们检索到 1712 条文献，其中 10 条符合纳入标准。方法学质量中等，主要结局不明确；样本量不足；使用的工具未标准化且未经验证。三项研究评估了达到特定表现基准的情况。两项研究显示维持了最低表现基准，而两项研究显示技能显著衰退。分别在四项研究中的四项、四项研究中的三项以及五项研究中的两项中观察到从模拟训练后立即到模拟训练后 3、6 和≥12 个月时平均表现得分显著下降。在四项研究中的三项、四项研究中的三项以及四项研究中的四项中，模拟训练后 3、6 和≥12 个月时得分仍显著高于基线。
研究模拟训练后关键技能记忆情况的研究数量有限。虽然有一些证据表明模拟训练后技能得以保留，但总体而言，大多数研究显示技能随时间下降。
