Gabarin Nadia, Trinkaus Martina, Selby Rita, Goldberg Nicola, Hanif Hina, Sholzberg Michelle
Department of Medicine, Michael G. DeGroote School of Medicine McMaster University Hamilton Ontario Canada.
Department of Medicine St. Michael's Hospital University of Toronto Toronto Ontario Canada.
Res Pract Thromb Haemost. 2022 Jun 17;6(4). doi: 10.1002/rth2.12746. eCollection 2022 May.
Coagulation testing provides a prime opportunity to make an impact on the reduction of unnecessary laboratory test ordering, as there are clear indications for testing. Despite the prothrombin time/international normalized ratio and activated partial thromboplastin time being validated for specific clinical indications, they are frequently ordered as screening tests and often ordered together, suggesting a gap in understanding of coagulation.
Based on a needs assessment, we developed an online educational module on coagulation for trainees, incorporating education on testing cost, specificity, and sensitivity. Fifty participating resident physicians and medical students completed a validated premodule quiz, postmodule quiz after completion of the module, and a latent quiz 3 to 6 months after to assess longer-term knowledge retention. Trainees provided responses regarding their subjective laboratory test-ordering practices before and after module completion.
The median premodule quiz score was 67% (n = 50; range, 24%-86%) with an increase of 24% to a median postmodule quiz score of 91% (n = 50; range, 64%-100%). There was evidence of sustained knowledge acquisition with a latent quiz median score of 89% (n = 40; range, 67%-100%). Trainees were more likely to consider the sensitivity, specificity, and cost of laboratory investigations before ordering them following completion of the educational module.
Using the expertise of medical educators and incorporating trainee feedback, we employed a novel approach to the teaching of coagulation to maximize its approachability and clinical relevance. We found sustained knowledge retention regarding coagulation and appropriate coagulation test ordering, and a subjective change to trainee ordering habits following participation in our educational intervention.
凝血检测为减少不必要的实验室检测医嘱提供了一个重要契机，因为检测有明确的指征。尽管凝血酶原时间/国际标准化比值和活化部分凝血活酶时间已针对特定临床指征得到验证，但它们经常被作为筛查检测项目开出，而且常常一起开具，这表明在凝血方面的理解存在差距。
基于需求评估，我们为学员开发了一个关于凝血的在线教育模块，纳入了检测成本、特异性和敏感性方面的教育内容。50名参与的住院医师和医学生完成了一个经过验证的模块前测验、模块完成后的模块后测验，以及3至6个月后的潜在测验，以评估长期知识保留情况。学员们提供了关于他们在模块完成前后主观实验室检测开具习惯的反馈。
模块前测验的中位数分数为67%（n = 50；范围为24% - 86%），增加了24%，模块后测验的中位数分数为91%（n = 50；范围为64% - 100%）。有证据表明知识得到持续获取，潜在测验的中位数分数为89%（n = 40；范围为67% - 100%）。在完成教育模块后，学员在开具实验室检查之前更有可能考虑其敏感性、特异性和成本。
利用医学教育工作者的专业知识并纳入学员反馈，我们采用了一种新颖的凝血教学方法，以最大限度地提高其易理解性和临床相关性。我们发现学员对凝血知识和适当的凝血检测开具具有持续的知识保留，并且在参与我们的教育干预后，学员的开具习惯有主观变化。
