Ashokka Balakrishnan, Narendiran Krishnasamy, Bhattacharya Abhijit, Pai Dinker, Liang Shen, Subramanian Shoba, Larmie Ernest T, Chen Fun Gee
Department of Anaesthesia, National University of Singapore, Yong Loo Lin School of Medicine, Singapore, Singapore.
Centre for Simulation, Taylor University, Subang Jaya, Selangor, Malaysia.
BMJ Simul Technol Enhanc Learn. 2016 Aug 18;2(4):103-107. doi: 10.1136/bmjstel-2016-000109. eCollection 2016.
Learning of simulation-based crisis management skills involves technologically advanced manikins and use of automated scenarios. Progressions in preprogrammed scenarios require finite task completion such as successful airway intubations for achieving optimal learning outcomes aligned to curricular goals. The study was set to explore the existing variability among various simulation manikins in use at our institute for undergraduate medical education.
56 final-year undergraduate students, who had received prior training in airway management skills, performed intubations on each of the 5 different manikins (56×5=280 intubations). The manikins used were the Human Patient Simulator (HPS), iStan & Emergency Care Simulator (ECS) from CAE Healthcare and Mega Code Kelly (MCK) and Airway Trainer (AWTR) from Laerdal. The students' performances were compared for success rates, ease of intubation, grade of laryngeal visualisation and presence of tooth injury on the manikins, Data from the intubations were cross-tabulated and evaluated by general estimating equation analysis using the Poisson model.
iStan had the higher rates of failure to intubate (64.3%). iStan (62.5%) and HPS (57.1%) had statistically significant teeth injury (p<0.0001) compared to other manikins. HPS and AWTR had the least difficult grades of laryngeal visualisation (Cormack Lehane grades 1 and 2), while the most difficult grade of visualisation (Cormack Lehane grades 3 and 4) was reported in ECS (44.6%).
Each of the high-technology manikins used in automated scenarios for crisis management teaching and learning has heterogeneity in airway features. Since frequent airway management is a critical component of simulation scenarios, this can affect student performance when these manikins are used for formative and summative high-stakes assessments.
基于模拟的危机管理技能学习涉及技术先进的人体模型和自动化场景的使用。预编程场景的进展需要完成有限的任务，例如成功进行气道插管，以实现与课程目标一致的最佳学习成果。本研究旨在探索我校用于本科医学教育的各种模拟人体模型之间现有的差异。
56名已接受气道管理技能预先培训的本科四年级学生，对5种不同的人体模型分别进行插管操作（56×5 = 280次插管）。所使用的人体模型包括CAE Healthcare公司的人体患者模拟器（HPS）、iStan和急救护理模拟器（ECS），以及Laerdal公司的高级综合模拟人（MCK）和气道训练器（AWTR）。比较学生在不同人体模型上的插管成功率、插管难易程度、喉部可视化分级以及人体模型上牙齿损伤情况。插管数据进行交叉制表，并使用泊松模型通过广义估计方程分析进行评估。
iStan插管失败率较高（64.3%）。与其他人体模型相比，iStan（62.5%）和HPS（57.1%）出现牙齿损伤的情况具有统计学意义（p<0.0001）。HPS和AWTR的喉部可视化分级难度最低（Cormack Lehane 1级和2级），而ECS的可视化分级难度最高（Cormack Lehane 3级和4级），占比为44.6%。
用于危机管理教学和学习的自动化场景中的每种高科技人体模型在气道特征方面都存在异质性。由于频繁的气道管理是模拟场景的关键组成部分，因此在将这些人体模型用于形成性和总结性高风险评估时，可能会影响学生的表现。
