DeMaria Samuel, Levine Adam, Petrou Philip, Feldman David, Kischak Patricia, Burden Amanda, Goldberg Andrew
Department of Anesthesiology, Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA.
Icahn School of Medicine at Mount Sinai Hospital, New York, New York, USA.
BMJ Simul Technol Enhanc Learn. 2017 Apr 5;3(2):37-42. doi: 10.1136/bmjstel-2016-000163. eCollection 2017.
Simulation is increasingly employed in healthcare provider education, but usage as a means of identifying system-wide practitioner gaps has been limited. We sought to determine whether practice gaps could be identified, and if meaningful improvement plans could result from a simulation course for anaesthesiology providers.
Over a 2-year cycle, 288 anaesthesiologists and 67 certified registered nurse anaesthetists (CRNAs) participated in a 3.5 hour, malpractice insurer-mandated simulation course, encountering 4 scenarios. 5 anaesthesiology departments within 3 urban academic healthcare systems were represented. A real-time rater scored each individual on 12 critical performance items (CPIs) representing learning objectives for a given scenario. Participants completed a course satisfaction survey, a 1-month postcourse practice improvement plan (PIP) and a 6-month follow-up survey.
All recorded course data were retrospectively reviewed. Course satisfaction was generally positive (88-97% positive rating by item). 4231 individual CPIs were recorded (of a possible 4260 rateable), with a majority of participants demonstrating remediable gaps in medical/technical and non-technical skills (97% of groups had at least one instance of a remediable gap in communication/non-technical skills during at least one of the scenarios). 6 months following the course, 91% of respondents reported successfully implementing 1 or more of their PIPs. Improvements in equipment/environmental resources or personal knowledge domains were most often successful, and several individual reports demonstrated a positive impact on actual practice.
This professional liability insurer-initiated simulation course for 5 anaesthesiology departments was feasible to deliver and well received. Practice gaps were identified during the course and remediation of gaps, and/or application of new knowledge, skills and resources was reported by participants.
模拟在医疗保健提供者教育中的应用日益广泛，但将其用作识别全系统从业者差距的手段却很有限。我们试图确定是否能够识别出实践差距，以及针对麻醉提供者的模拟课程是否能产生有意义的改进计划。
在为期两年的周期内，288名麻醉医师和67名注册护士麻醉师（CRNA）参加了一个时长3.5小时、由医疗事故保险公司强制要求的模拟课程，共经历4个场景。该课程涵盖了3个城市学术医疗系统中的5个麻醉科。一名实时评分员根据代表给定场景学习目标的12个关键绩效指标（CPl）对每位参与者进行评分。参与者完成了课程满意度调查、课程结束后1个月的实践改进计划（PIP）以及6个月后的随访调查。
对所有记录的课程数据进行了回顾性审查。课程满意度总体呈积极态度（各项目的积极评价率为88%-97%）。共记录了4231个个人CPl（可能的可评分数量为4260个），大多数参与者在医疗/技术和非技术技能方面存在可补救的差距（97%的小组在至少一个场景中，在沟通/非技术技能方面至少有一次可补救的差距情况）。课程结束6个月后，91%的受访者报告成功实施了1项或多项PIP。设备/环境资源或个人知识领域的改进最为成功，一些个人报告显示对实际实践产生了积极影响。
这个由专业责任保险公司发起、面向5个麻醉科的模拟课程实施可行且受到好评。课程期间识别出了实践差距，参与者报告了差距的补救情况和/或新知识、技能及资源的应用情况。
