Bretagne Vincent, Delapierre Alice, Cerasuolo Damiano, Bellot Anne, Marcelli Christian, Guillois Bernard
Caen University Hospital, Caen, France.
University of Caen Normandy, Caen, France.
ACR Open Rheumatol. 2022 Apr;4(4):312-321. doi: 10.1002/acr2.11400. Epub 2022 Jan 6.
The study objective was to assess the efficacy of simulators in improving the competence of students in performing a knee and shoulder arthrocentesis on cadavers and to determine the minimum number of simulator training procedures needed to achieve competence in arthrocentesis.
Two groups of 15 medical students were each trained to perform a single joint arthrocentesis ("knee group" and "shoulder group") on a simulator to serve as a control for the other. The two groups received the same theoretical training (anatomy, arthrocentesis techniques, ultrasound, and hybrid simulation). Each student punctured the two joints on a cadaver. A student was considered "competent on the cadaver" if they succeeded at two or more arthrocentesis procedures out of the three tests on the joint on which they were trained. The minimum threshold value to be competent was calculated by a receiver operating characteristic curve and the Youden index. An assessment of theoretical knowledge and confidence level in joint arthrocentesis was carried out at the start and end of the study.
Twenty-two out of 29 students (75.8%) achieved competence in arthrocentesis at the joint for which they were trained. Of the students in the knee group, 79% were competent on the cadaver's knee versus 60% of the students in the shoulder group (P = 0.43). Of students in the shoulder group, 74% were competent on the cadaver's shoulder versus 57% of students in the knee group (P = 0.45). Four training punctures on a simulator are necessary to achieve competence on a cadaver. The students' confidence level in arthrocentesis increased significantly during the study, as did the students' theoretical knowledge.
Knee and shoulder arthrocentesis success rates were not statistically different between the two training groups. A minimum number of 4.0 training arthrocentesis on a simulator is needed to achieve competency on a cadaver.
本研究的目的是评估模拟器在提高学生在尸体上进行膝关节和肩关节穿刺术能力方面的效果，并确定达到穿刺术能力所需的模拟器训练程序的最少次数。
两组各15名医学生分别接受在模拟器上进行单关节穿刺术的训练（“膝关节组”和“肩关节组”），两组相互作为对照。两组接受相同的理论培训（解剖学、穿刺术技术、超声和混合模拟）。每名学生在一具尸体上对两个关节进行穿刺。如果学生在其接受训练的关节的三次测试中有两次或更多次穿刺成功，则认为该学生“在尸体上具备能力”。通过受试者工作特征曲线和尤登指数计算出具备能力的最低阈值。在研究开始和结束时对关节穿刺术的理论知识和信心水平进行评估。
29名学生中有22名（75.8%）在其接受训练的关节穿刺术上达到了能力要求。膝关节组中，79%的学生在尸体膝关节穿刺方面具备能力，而肩关节组为60%（P = 0.43）。肩关节组中，74%的学生在尸体肩关节穿刺方面具备能力，而膝关节组为57%（P = 0.45）。在模拟器上进行四次训练穿刺是在尸体上达到能力要求所必需的。在研究过程中，学生对穿刺术的信心水平显著提高，学生的理论知识也有所提高。
两个训练组之间膝关节和肩关节穿刺术的成功率在统计学上没有差异。在模拟器上进行最少4.0次训练穿刺才能在尸体上达到能力要求。
