Johnston Lindsay C, Chen Ruijun, Whitfill Travis M, Bruno Christie J, Levit Orly L, Auerbach Marc A
Department of Pediatrics, Yale University School of Medicine, New Haven, Connecticut, USA.
Department of Medicine, University of California at San Francisco School of Medicine, San Francisco, California, USA.
BMJ Simul Technol Enhanc Learn. 2015 May 20;1(1):12-18. doi: 10.1136/bmjstel-2015-000031. eCollection 2015.
Direct laryngoscopy (DL) and airway intubation are critical for neonatal resuscitation. A challenge in teaching DL is that the instructor cannot assess the learners' airway view. Videolaryngoscopy (VL), which allows display of a patient's airway on a monitor, enables the instructor to view the airway during the procedure. This pilot study compared deliberate practice using either VL with instruction (I-VL) or traditional DL. We hypothesised that I-VL would improve the efficiency and effectiveness of neonatal intubation (NI) training.
Participants (students, paediatric interns and neonatal fellows) were randomised to I-VL or DL. Baseline technical skills were assessed using a skills checklist and global skills assessment. Following educational sessions, deliberate practice was performed on mannequins using the Storz C-MAC. With I-VL, the instructor could guide training using a real-time airway monitor view. With DL, feedback was based solely on technique or direct visual confirmation, but the instructor and learner views were not concurrent. During summative assessment, procedural skills checklists were used to evaluate intubation ability on a neonatal airway trainer. The duration of attempts was recorded, and recorded airway views were blindly reviewed for airway grade. 'Effectiveness' reflected achievement of the minimum passing score (MPS). 'Efficiency' was the duration of training for learners achieving the MPS.
58 learners were randomised. Baseline demographics were similar. All participants had a significant improvement in knowledge, skills and comfort/confidence following training. There were no significant differences between randomised groups in efficiency or effectiveness, but trends towards improvement in each were noted. Fellows were more likely to achieve 'competency' postinstruction compared to non-fellows (p<0.001).
This educational intervention to teach NI increased the learner's knowledge, technical skills and confidence in procedural performance in both groups. I-VL did not improve training effectiveness. The small sample size and participant diversity may have limited findings, and future work is indicated.
直接喉镜检查（DL）和气道插管对于新生儿复苏至关重要。DL教学中的一个挑战是教员无法评估学习者的气道视野。视频喉镜检查（VL）可在监视器上显示患者气道，使教员能够在操作过程中观察气道。这项前瞻性研究比较了使用带指导的VL（I-VL）或传统DL进行的刻意练习。我们假设I-VL将提高新生儿插管（NI）培训的效率和效果。
参与者（学生、儿科实习生和新生儿专科医生）被随机分为I-VL组或DL组。使用技能清单和整体技能评估来评估基线技术技能。在教育课程之后，使用史托斯C-MAC在人体模型上进行刻意练习。对于I-VL，教员可以使用实时气道监视器视野来指导培训。对于DL，反馈仅基于技术或直接视觉确认，但教员和学习者的视野不同步。在总结性评估期间，使用程序技能清单来评估在新生儿气道训练器上的插管能力。记录尝试的持续时间，并对记录的气道视野进行盲法审查以确定气道分级。“效果”反映了最低及格分数（MPS）的达成情况。“效率”是达到MPS的学习者的培训持续时间。
58名学习者被随机分组。基线人口统计学特征相似。所有参与者在培训后知识、技能和舒适度/信心方面都有显著提高。随机分组之间在效率或效果方面没有显著差异，但在每个方面都注意到了改善的趋势。与非专科医生相比，专科医生在教学后更有可能达到“胜任”水平（p<0.001）。
这项教授NI的教育干预提高了两组学习者的知识、技术技能和操作表现信心。I-VL并没有提高培训效果。样本量小和参与者的多样性可能限制了研究结果，因此需要开展进一步研究。
