McKay Jheanelle, Wasserman Mollie, Monuteaux Michael C, Hirsch Alexander W, Nagler Joshua
Department of Pediatric Emergency Medicine Joe DiMaggio Children's Hospital Hollywood Florida USA.
Division of Pediatric Hospital Medicine Boston Children's Hospital Boston Massachusetts USA.
AEM Educ Train. 2023 Jun 22;7(3):e10886. doi: 10.1002/aet2.10886. eCollection 2023 Jun.
Pediatric requirements include procedural skills training such as peripheral intravenous (PIV) catheter placement and bag-mask ventilation (BMV). Clinical experiences may be limited and temporally remote from scheduled teaching. Just-in-time (JIT) training prior to utilization can promote skill development and mitigate learning decay. Our objective was to assess the impact of JIT training on pediatric residents' procedural performance, knowledge, and confidence with PIV placement and BMV.
Residents received standardized baseline training in both PIV placement and BMV during scheduled educational programming. Between 3 and 6 months later, participants were randomized and received JIT training for either PIV placement or BMV. JIT training included a brief video and coached practice, totaling <5 min. Each participant was videotaped performing both procedures on skills trainers. Blinded investigators scored performance using skills checklists. Pre- and postintervention knowledge was assessed using multiple-choice and short-answer items, and confidence was reported using Likert scores.
Seventy-two residents completed baseline training sessions: 36 were randomized to receive JIT training for PIV and 36 for BMV. Thirty-five residents in each cohort completed the curriculum. There were no significant differences between the cohorts with regard to demographics, baseline knowledge, or prior simulation experience. JIT training was associated with improved procedural performance for PIV (median 87% vs. 70%, < 0.001) and for BMV (mean 83% vs. 57%, < 0.001). Results remained significant after using regression models to adjust for differences in prior clinical experience. Improvements in knowledge or confidence were not associated with JIT training in either cohort.
JIT training resulted in a significant improvement in resident procedural performance with PIV placement and BMV in a simulated environment. There were no differences in outcome with regard to knowledge or confidence. Future work might explore how the demonstrated benefit translates into the clinical setting.
儿科培训要求包括诸如外周静脉（PIV）导管置入和袋-面罩通气（BMV）等操作技能培训。临床经验可能有限，且与预定教学在时间上相隔较远。在实际操作前进行即时（JIT）培训可促进技能发展并减轻学习遗忘。我们的目的是评估JIT培训对儿科住院医师PIV置管和BMV操作表现、知识及信心的影响。
住院医师在预定的教育课程中接受PIV置管和BMV的标准化基线培训。在3至6个月后，参与者被随机分组，接受PIV置管或BMV的JIT培训。JIT培训包括一段简短视频和带指导的练习，总计<5分钟。每位参与者在技能训练器上进行这两项操作时都被录像。不知情的研究者使用技能清单对操作表现进行评分。干预前后的知识通过多项选择题和简答题进行评估，信心则用李克特量表评分报告。
72名住院医师完成了基线培训课程：36人被随机分组接受PIV的JIT培训，36人接受BMV的JIT培训。每个队列中有35名住院医师完成了课程。两组在人口统计学、基线知识或既往模拟经验方面无显著差异。JIT培训与PIV操作表现的改善相关（中位数87%对70%，<0.001）以及BMV操作表现的改善相关（均值83%对57%，<0.001）。在使用回归模型调整既往临床经验差异后，结果仍具有显著性。两组中知识或信心的改善均与JIT培训无关。
JIT培训使住院医师在模拟环境中进行PIV置管和BMV的操作表现有显著改善。在知识或信心方面结果无差异。未来的工作可能会探索所显示的益处如何转化到临床环境中。
