临床前医师助理学生的紧急关键技能培训：培训方法的混合方法比较

Emergency Critical Skills Training for Pre-clinical Physician Assistant Students: Mixed Method Comparison of Training Method.

作者信息

Moon Mary B, Darden Alix, Hill Molly, Roberts Megan K, Varalli-Claypool Bruna, Miller Frederick C

机构信息

Department of Cell Biology, University of Oklahoma Science Center, Oklahoma City, OK USA.

University of Arkansas for Medical Sciences, Little Rock, AR USA.

出版信息

Med Sci Educ. 2022 Jul 1;32(4):837-845. doi: 10.1007/s40670-022-01575-0. eCollection 2022 Aug.

DOI:10.1007/s40670-022-01575-0

PMID:36035540

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9411425/

Abstract

INTRODUCTION

The fast-paced nature of physician assistant (PA) programs warrants an emphasis on high-fidelity, critical care skills training. Generally, manikins or task trainers are used for training and assessing. Soft-preserved cadavers provide a high-fidelity model to teach high-acuity, low-opportunity procedures; however, their effectiveness in PA pre-clinical training is not well understood.

OBJECTIVE

This study compared procedural competency of task trainer and soft-preserved cadaver trained pre-clinical PA (pcPA) students in completing tube thoracostomy, endotracheal intubation, intraosseous infusion, and needle thoracostomy.

METHODS

A randomized controlled study was conducted with pcPA students ( = 48) at a midwestern program. Participants were randomly assigned to cadaver trained (CT), task trainer (TT), or control group (CG). We assessed procedural competency using skill-specific rubrics and performed qualitative analysis of student comments regarding skill-specific procedural preparedness.

RESULTS

Intervention groups surpassed the control group on all skills. The CT students exhibited significantly higher procedural competency compared to TT-trained students in endotracheal intubation ( = 0.0003) and intraosseous infusion ( = 0.0041). Thematic analysis of student comments revealed pre-training students consistently felt unprepared and lacked confidence to perform needle thoracostomy, tube thoracostomy, and endotracheal intubation. Post-training perceptions, CT/TT, focused on preparedness and confidence. The CT group also consistently described the impact of realistic simulation.

CONCLUSION

High-fidelity training with soft-preserved cadavers may be the most effective way to prepare pcPA students to perform endotracheal intubation and intraosseous infusion. Student perspectives on procedural preparedness highlight the importance of multidimensional, realistic training methods.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40670-022-01575-0.

摘要

引言

医师助理（PA）项目的快节奏性质要求强调高保真的重症护理技能培训。一般来说，人体模型或任务训练器用于培训和评估。软质保存尸体提供了一个高保真模型，用于教授高难度、机会较少的操作；然而，它们在PA临床前培训中的有效性尚未得到充分了解。

目的

本研究比较了任务训练器和软质保存尸体培训的临床前PA（pcPA）学生在完成胸腔闭式引流、气管插管、骨内输液和胸腔穿刺术方面的操作能力。

方法

在一个中西部项目中对pcPA学生（n = 48）进行了一项随机对照研究。参与者被随机分配到尸体培训组（CT）、任务训练器组（TT）或对照组（CG）。我们使用特定技能的评分标准评估操作能力，并对学生关于特定技能操作准备情况的评论进行定性分析。

结果

干预组在所有技能上均超过对照组。与TT培训的学生相比，CT组学生在气管插管（P = 0.0003）和骨内输液（P = 0.0041）方面表现出显著更高的操作能力。对学生评论的主题分析显示，培训前学生一直觉得没有准备好，并且缺乏进行胸腔穿刺术、胸腔闭式引流和气管插管的信心。培训后的认知，CT/TT组，集中在准备情况和信心上。CT组也一直描述了逼真模拟的影响。