Devlin-Hegedus Jessica, Miller Matthew, Cooke Sean, Ware Sandra, Richmond Clare
Wollongong Hospital Wollongong New South Wales Australia.
NSW Ambulance Rozelle New South Wales Australia.
AEM Educ Train. 2023 Jul 11;7(4):e10894. doi: 10.1002/aet2.10894. eCollection 2023 Aug.
The use of directed observers in high-fidelity simulation education is increasingly common. While evidence suggests similar educational outcomes for directed observers compared to active participants in technical skills, it remains uncertain if this benefit also exists for senior clinicians, especially in mental workload. We sought to compare the workload between active participants and directed observers using an objective measure.
We performed a prospective, repeated-measures observational study during the New South Wales Ambulance Aeromedical Operations induction training from 2019 to 2020. Participants included senior critical care doctors, paramedics, and nurses undergoing high-fidelity simulation of prehospital and interhospital aeromedical missions. Task load was measured using the National Aeronautics and Space Administration task load index (NASA-TLX) administered following each simulation debrief. Prehospital and interhospital simulations were compared separately by building a multilevel model for complete case and all study data. Post hoc comparisons of NASA-TLX score for each group were performed using estimated marginal means (EMMs).
We enrolled 70 participants, comprising 49 physicians (70%), 19 paramedics (27%), and two flight nurses (3%). From the complete case analysis, statistically significant differences were observed for total NASA-TLX scores between active participants and directed observers in both prehospital (participant EMM 78, observer EMM 65, estimated difference -13, 95% confidence interval [CI] -20 to -7) and interhospital simulations (participant EMM 69, observer EMM 59, estimated difference -10, 95% CI -16 to -3). When all available data were included, the pattern of results did not change.
In our sample of senior clinicians, the task load experienced by both active participants and directed observers in high-fidelity simulation education was high for both prehospital and interhospital simulation exercises. The statistically significant differences we report are unlikely to be practically significant. Our results support the use of directed observers when resource limitations do not allow all course attendees to participate in every simulation.
在高保真模拟教育中使用定向观察者的情况越来越普遍。虽然有证据表明，与技术技能培训中的主动参与者相比，定向观察者能取得相似的教育成果，但对于资深临床医生而言，这种益处是否也存在，尤其是在心理负荷方面，仍不确定。我们试图通过一种客观测量方法来比较主动参与者和定向观察者之间的负荷。
我们在2019年至2020年新南威尔士州救护车航空医疗行动入职培训期间进行了一项前瞻性、重复测量观察性研究。参与者包括接受院前和院间航空医疗任务高保真模拟培训的资深重症医生、护理人员和护士。在每次模拟总结后，使用美国国家航空航天局任务负荷指数（NASA-TLX）测量任务负荷。通过为完整病例和所有研究数据建立多层次模型，分别对院前和院间模拟进行比较。使用估计边际均值（EMM）对每组的NASA-TLX分数进行事后比较。
我们招募了70名参与者，包括49名医生（70%）、19名护理人员（27%）和两名飞行护士（3%）。从完整病例分析来看，在院前模拟（参与者EMM为78，观察者EMM为65，估计差异为-13，95%置信区间[CI]为-20至-7）和院间模拟（参与者EMM为69，观察者EMM为59，估计差异为-10，95%CI为-16至-3）中，主动参与者和定向观察者之间的总NASA-TLX分数均存在统计学显著差异。当纳入所有可用数据时，结果模式没有改变。
在我们选取资深临床医生的样本中，无论是院前还是院间模拟练习，主动参与者和定向观察者在高保真模拟教育中所经历的任务负荷都很高。我们报告的统计学显著差异在实际中不太可能具有显著意义。我们的结果支持在资源有限无法让所有课程参与者都参与每次模拟时使用定向观察者。
