E J Sree Kumar, Purva Makani, Chander M Sarat, Parameswari Aruna
Anaesthesiology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India.
Hull and East Yorkshire Hospitals NHS Trust, Hull, UK.
BMJ Simul Technol Enhanc Learn. 2020 Nov 1;6(6):351-355. doi: 10.1136/bmjstel-2019-000496. eCollection 2020.
Little is known about the learning curve characteristics of residents undertaking simulation-based education. It is important to understand the time for acquisition and decay of knowledge and skills needed to manage rare and difficult clinical situations.
Ten anaesthesiology residents underwent simulation-based education to manage a cannot intubate cannot ventilate scenario during general anaesthesia for caesarean section. Their performance was measured using an assessment tool and debriefed by two experienced anaesthesiologists. The parameters against which the performance was judged were grouped into preoperative assessment, preoperative patient care, equipment availability, induction sequence, communication and adherence to airway algorithm protocol. The scenario was repeated at 6 and 12 months thereafter. The residents' acquisition of knowledge, technical and non-technical skills were assessed and compared at baseline, 6 months and end of 12 months.
The skills of preoperative assessment, preoperative care and communication quickly improved but the specific skill of managing a difficult airway as measured by adherence to an airway algorithm required more than 6 months (CI at 6 vs 12 months: -3.4 to -0.81, p=0.016). The skills of preoperative assessment and preoperative care improved to a higher level quickly and were retained at this improved level. Communication (CI at 0 vs 6 months: -3.78 to -0.22, p=0.045 and at 6 vs 12 months : -3.39 to -1.49, p=0.007) and difficult airway management skill were slower to improve but continued to do so over the 12 months. The compliance to machine check was more gradual and showed an improvement at 12 months.
Our study is unique in analysing the learning curve characteristics of different components of a failed obstetric airway management skill. Repeated simulations over a longer period of time help in better reinforcement, retention of knowledge, recapitulation and implementation of technical and non-technical skills.
对于接受基于模拟的教育的住院医师的学习曲线特征，人们了解甚少。了解掌握处理罕见和困难临床情况所需知识和技能的获取及衰退时间很重要。
十名麻醉科住院医师接受了基于模拟的教育，以处理剖宫产全身麻醉期间无法插管无法通气的情况。使用评估工具衡量他们的表现，并由两名经验丰富的麻醉医生进行总结汇报。用于评判表现的参数分为术前评估、术前患者护理、设备可用性、诱导顺序、沟通以及对气道算法协议的遵守情况。此后在6个月和12个月时重复该场景。在基线、6个月和12个月末评估并比较住院医师的知识、技术和非技术技能的掌握情况。
术前评估、术前护理和沟通技能迅速提高，但通过遵守气道算法衡量的处理困难气道的特定技能需要超过6个月的时间（6个月与12个月时的置信区间：-3.4至-0.81，p = 0.016）。术前评估和术前护理技能迅速提高到更高水平，并保持在这一改善后的水平。沟通（0个月与6个月时的置信区间：-3.78至-0.22，p = 0.045；6个月与12个月时：-3.39至-1.49，p = 0.007）和困难气道管理技能改善较慢，但在12个月内持续改善。对机器检查的依从性更为渐进，在12个月时有所改善。
我们的研究在分析产科气道管理失败技能不同组成部分的学习曲线特征方面具有独特性。在较长时间内重复模拟有助于更好地强化、保留知识以及复习和实施技术与非技术技能。
