Lemke Daniel S, Young Ann L, Won Sharon K, Rus Marideth C, Villareal Nadia N, Camp Elizabeth A, Doughty Cara
Division of Emergency Medicine Department of Pediatrics Baylor College of Medicine Texas Children's Hospital Houston Texas USA.
Division of Emergency Medicine Boston Children's Hospital Boston Massachusetts USA.
AEM Educ Train. 2021 Aug 1;5(4):e10702. doi: 10.1002/aet2.10702. eCollection 2021 Aug.
The optimal structure of simulation to train teams to perform pediatric advanced life support (PALS) requires further research. Most simulation is structured with an uninterrupted scenario with postsimulation debriefing (PSD). Rapid-cycle deliberate practice (RCDP) is structured with a series of simulations with microdebriefing quickly switching within action targeting specific performance goals.
The objective was to compare team performance immediately after training, as well as learner workload, for teams trained using either PSD or RCDP.
In 2018-2019, a total of 41 interprofessional teams of 210 residents and nurses were recruited from 250 eligible participants (84%) and randomized into either arm (RCDP or PSD) teaching the same objectives of resuscitation of a patient in PEA arrest, in the same time frame. The structure of the simulation varied. Demographic surveys were collected before training, the National Aeronautics and Space Administration-Task Load Index (NASA-TLX) was administered immediately after training to assess workload during training and performance was assessed immediately after training using a pulseless ventricular tachycardia arrest with the primary outcome being time to defibrillation.
Thirty-nine teams participated over a 16-month time span. Performance of teams randomized to RCDP showed significantly better time to defibrillation, 100 s (95% confidence interval [CI] = 90-111), compared to PSD groups, 163 s (95% CI = 120-201). The workload of the groups also showed a lower total NASA-TLX score for the RCDP groups.
For team-based time-sensitive training of PALS, RCDP outperformed PSD. This may be due to a reduction in the workload faced by teams during training.
训练团队执行儿科高级生命支持（PALS）的模拟最佳结构需要进一步研究。大多数模拟采用不间断的场景并进行模拟后汇报（PSD）。快速循环刻意练习（RCDP）则是通过一系列模拟以及微观汇报来构建，在行动过程中迅速切换，以实现特定的绩效目标。
比较使用PSD或RCDP训练的团队在训练后即刻的团队表现以及学习者工作量。
在2018 - 2019年，从250名符合条件的参与者中招募了41个由210名住院医师和护士组成的跨专业团队（84%），并随机分为两组（RCDP或PSD），在相同时间框架内教授相同的无脉电活动（PEA）心脏骤停患者复苏目标。模拟结构有所不同。在训练前收集人口统计学调查数据，训练后立即使用美国国家航空航天局任务负荷指数（NASA - TLX）评估训练期间的工作量，并在训练后立即使用无脉室性心动过速心脏骤停评估表现，主要结局指标为除颤时间。
在16个月的时间跨度内，39个团队参与了研究。随机分配到RCDP组的团队除颤时间明显更短，为100秒（95%置信区间[CI]=90 - 111），而PSD组为163秒（95% CI = 120 - 201）。RCDP组的总体NASA - TLX得分也较低。
对于基于团队的对时间敏感的PALS训练，RCDP的表现优于PSD。这可能是由于训练期间团队面临的工作量减少。
