Smith Alexander W, Elliott John O, Gable Brad D
Internal Medicine, Riverside Methodist Hospital, Columbus, USA.
Medical Education, OhioHealth Research Institute, Columbus, USA.
Cureus. 2021 Jul 26;13(7):e16648. doi: 10.7759/cureus.16648. eCollection 2021 Jul.
Introduction While many graduate medical education programs require residents to be certified in advanced cardiac life support, this does not cover all aspects of cardiac stabilization in patients with a pulse. Residents are often on the front lines of providing care to patients with life-threatening dysrhythmias. Our residents expressed a lack of confidence in their ability to provide this care. Methods A convenience sample of internal medicine, preliminary medicine, and transitional year residents from our large community-based tertiary care hospital participated in our survey and training. We utilized a pre-post survey method of our residents' confidence in domains that are critical to caring for patients requiring cardiac resuscitation and stabilization. Our pre-post survey was a modified Likert scale. Our training consisted of a 1-hour faculty-led hands-on training session focused on these critical domains in our hospital's simulation suites. Follow-up survey data were collected immediately after the training and at six and 11 months after the training using mean confidence across all five domains as the study variable. Results Resident mean confidence in the five domains (placing leads and pads, manipulating defibrillator controls, performing defibrillation, performing synchronized cardioversion, and performing transcutaneous pacemaker use) increased immediately after our training compared to before the training (p<0.001). This increase in confidence from before the training was sustained at six and 11 months after the training (p=0.001 and p=0.002, respectively). Confidence was lower at six and 11 months than immediately after training (p=0.01 and p=0.004, respectively). Conclusion Our project showed that simulation-based training was effective in improving our trainee's confidence in providing care to patients with life-threatening dysrhythmias. As with previous studies in simulation, confidence degradation was seen over time and likely mirrors skill degradation in these low-frequency encounters. As such, future aims include identification of ideal time intervals between training.
引言 虽然许多毕业后医学教育项目要求住院医师获得高级心血管生命支持认证，但这并未涵盖有脉搏患者心脏稳定的所有方面。住院医师常常处于为患有危及生命的心律失常患者提供护理的第一线。我们的住院医师表示对自己提供此类护理的能力缺乏信心。方法 来自我们大型社区三级护理医院的内科、初级医学和过渡年住院医师的便利样本参与了我们的调查和培训。我们采用了前后调查方法，评估住院医师在对需要心脏复苏和稳定的患者进行护理至关重要的领域的信心。我们的前后调查采用了改良的李克特量表。我们的培训包括由教员带领的1小时实践培训课程，重点关注医院模拟套房中的这些关键领域。培训结束后立即以及培训后6个月和11个月收集后续调查数据，将所有五个领域的平均信心作为研究变量。结果 与培训前相比，培训后住院医师在五个领域（放置导联和电极片、操作除颤器控制、进行除颤、进行同步心脏复律和使用经皮起搏器）的平均信心立即提高（p<0.001）。培训前到培训后信心的这种增加在培训后6个月和11个月得以维持（分别为p=0.001和p=0.002）。6个月和11个月时的信心低于培训后立即的信心（分别为p=0.01和p=0.004）。结论 我们的项目表明，基于模拟的培训有效地提高了我们学员对为患有危及生命的心律失常患者提供护理的信心。与先前模拟研究一样，随着时间的推移信心出现下降，这可能反映了这些低频情况下技能的下降。因此，未来的目标包括确定培训之间的理想时间间隔。
