Leng Owain Michael, Rothwell Charlotte, Buckton Annamarie, Elmer Catherine, Illing Jan, Metcalf Jane
Department of Endocrinology, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
School of Medical Education, Newcastle University, Newcastle upon Tyne, UK.
BMJ Simul Technol Enhanc Learn. 2018 Oct 4;4(4):190-195. doi: 10.1136/bmjstel-2017-000228. eCollection 2018.
The patient safety agenda has propelled the rise of simulation education, but relatively few evaluations of simulation-based educational interventions have focused on patient outcomes.
To evaluate the impact of an in situ, high-fidelity simulation teaching intervention on the management of community-acquired pneumonia in the ambulatory care unit of a district general hospital.
This study used a mixed-methods approach to evaluate the impact of a programme of 10 in situ high-fidelity simulation education sessions delivered to a total of 10 junior doctors, nine nurses and seven healthcare assistants. Participants were tasked with managing a manikin simulating a patient with pneumonia in real time in a working clinical area. Subsequent structured debrief emphasised key themes from the national guidelines on pneumonia management. The intervention was evaluated through an immediate feedback form, follow-up semistructured interviews by independent qualitative researchers that underwent content analysis and triangulation with audit data on compliance with national pneumonia guidelines before and after the simulation intervention.
The in situ simulation intervention was valued by participants both in immediate written feedback and in follow-up semistructured interviews. In these interviews, 17 of 18 participants were able to identify a self-reported change in practice following the simulation intervention. Furthermore, most participants reported observing a change in the clinical practice of their colleagues following the training. Collected audit data did not show a statistically significant change in compliance with the guidelines for the management of pneumonia.
This study found evidence of a change in both self-reported and observed clinical practice following a simulation intervention, supporting expert opinion that simulation education can impact clinician behaviours and patient outcomes in complex clinical scenarios. Furthermore, this feasibility study provides a transferrable method to evaluate the real-world impact of simulation education that merits further investigation through an appropriately powered study.
患者安全议程推动了模拟教育的兴起，但相对较少的基于模拟的教育干预评估关注患者结局。
评估现场高保真模拟教学干预对地区综合医院门诊护理单元社区获得性肺炎管理的影响。
本研究采用混合方法评估了一项针对10名初级医生、9名护士和7名医疗辅助人员开展的10次现场高保真模拟教育课程计划的影响。参与者的任务是在实际临床区域实时管理模拟肺炎患者的人体模型。随后的结构化汇报强调了国家肺炎管理指南中的关键主题。通过即时反馈表、独立定性研究人员进行的后续半结构化访谈对干预进行评估，这些访谈进行了内容分析，并与模拟干预前后符合国家肺炎指南的审核数据进行了三角验证。
现场模拟干预在即时书面反馈和后续半结构化访谈中都受到了参与者的重视。在这些访谈中，18名参与者中有17名能够识别出模拟干预后自我报告的实践变化。此外，大多数参与者报告称在培训后观察到同事的临床实践有变化。收集的审核数据未显示在肺炎管理指南的遵循方面有统计学上的显著变化。
本研究发现有证据表明模拟干预后自我报告和观察到的临床实践都发生了变化，支持了专家观点，即模拟教育可以在复杂临床场景中影响临床医生行为和患者结局。此外，这项可行性研究提供了一种可转移的方法来评估模拟教育的实际影响，值得通过一项有足够样本量的研究进行进一步调查。
