Gino Bruno, Benson Andy, Dubrowski Adam
Emergency Medicine, Memorial University of Newfoundland, St. John's, CAN.
Health Sciences, Ontario Tech University, Oshawa, CAN.
Cureus. 2023 Jun 21;15(6):e40729. doi: 10.7759/cureus.40729. eCollection 2023 Jun.
Introduction The challenges of delivering cardiac arrest (CA) courses in rural and remote (R&R) locations worldwide have been further exacerbated by the COVID-19 pandemic. However, it is important to note that this problem has always existed. The implementation of social distancing measures to combat the pandemic has had a significant impact on healthcare and medical education, particularly in relation to the training of students, laypeople (LP), and healthcare professionals (HCPs) in CA care. The combination of pandemic restrictions and pre-existing difficulties faced in R&R locations and large cities has disrupted the provision of comprehensive medical education. The suspension of basic life support and defibrillation (BLSD) courses during the pandemic may have negatively affected pre-hospital care for CA. However, it is essential to acknowledge that challenges in delivering these courses in R&R areas predate the pandemic. Materials and methods A 2021 epidemiological study in the Brazilian Amazon identified CA as the primary cause of death, followed by COVID-19. This highlights the importance of providing BLSD courses and training to emergency medical service (EMS) personnel in R&R locations. Even during a pandemic. Researchers from Ontario Tech University and Memorial University School of Medicine developed a drone with a simulation scenario to train HCPs in automated external defibrillators (AED) operation and guide LP in safe use through BLSD protocols. A literature review showed that different training methods yielded similar outcomes. Based on these findings, the evidence-development-validation-consensus (EDVC) hybrid approach was used to develop and validate an online training program using a learning management system (LMS) as a model. Results Teaching HCPs and LP in R&R locations, such as northern Canada and the Brazilian Amazon, presents challenges due to limited resources and internet access. One potential solution lies in the utilization of remote online LMS that facilitate the administration, documentation, tracking, reporting, automation, and delivery of educational courses and training programs. The literature review indicated that mixed training approaches, including face-to-face, online, and hybrid formats, produced similar outcomes in learning assessment, self-confidence, performance, skills, and knowledge acquisition. These findings support the viability of using LMS as a model to develop and validate a course where drones deliver AEDs and provide training to HCPs and LP in R&R locations. A comprehensive training program should encompass cognitive, affective, and psychomotor learning domains, addressing various skills and knowledge aspects. Conclusion This research study develops and validates LMS teaching methods to support a training program for HCPs and LP in using AEDs delivered by drones. The program combines design-based research and consensus development methods, such as design thinking and think-aloud observations. Drones are used to provide AEDs and develop simulation scenarios for training in R&R locations. The hybrid approach ensures a valid and evidence-based training program. The study presents the EDVC approach used to enhance the maxSIMdrone training program, enabling effective out-of-hospital CA care. The program incorporates participant feedback and improves knowledge and techniques in AED use. It has the potential to improve patient outcomes in resource-limited R&R locations.
引言 全球范围内,新冠疫情进一步加剧了在农村和偏远地区开展心脏骤停(CA)课程的挑战。然而,需要注意的是,这个问题一直存在。为抗击疫情而实施的社交距离措施对医疗保健和医学教育产生了重大影响,特别是在CA护理方面对学生、非专业人员(LP)和医疗保健专业人员(HCP)的培训。疫情限制与农村和偏远地区以及大城市先前面临的困难相结合,扰乱了全面医学教育的提供。疫情期间基础生命支持和除颤(BLSD)课程的暂停可能对CA的院前护理产生了负面影响。然而,必须认识到,在农村和偏远地区开展这些课程的挑战在疫情之前就已存在。
材料与方法 2021年在巴西亚马逊地区进行的一项流行病学研究确定CA是主要死因,其次是新冠病毒。这凸显了在农村和偏远地区为紧急医疗服务(EMS)人员提供BLSD课程和培训的重要性,即使在疫情期间也是如此。安大略理工大学和纪念大学医学院的研究人员开发了一种带有模拟场景的无人机,用于培训HCP使用自动体外除颤器(AED),并通过BLSD协议指导LP安全使用。文献综述表明,不同的培训方法产生了相似的结果。基于这些发现,采用证据开发 - 验证 - 共识(EDVC)混合方法,以学习管理系统(LMS)为模型开发并验证了一个在线培训项目。
结果 在加拿大北部和巴西亚马逊等农村和偏远地区培训HCP和LP存在挑战,因为资源和互联网接入有限。一种潜在的解决方案是利用远程在线LMS,它有助于管理、记录、跟踪、报告、自动化以及提供教育课程和培训项目。文献综述表明,包括面对面、在线和混合形式在内的混合培训方法在学习评估、自信心、表现、技能和知识获取方面产生了相似的结果。这些发现支持了以LMS为模型开发和验证一门课程的可行性,该课程中无人机可递送AED并为农村和偏远地区的HCP和LP提供培训。一个全面的培训项目应涵盖认知、情感和心理运动学习领域,涉及各种技能和知识方面。
结论 本研究开发并验证了LMS教学方法,以支持针对HCP和LP使用无人机递送的AED的培训项目。该项目结合了基于设计的研究和共识发展方法,如设计思维和出声思考观察。无人机用于提供AED并开发模拟场景,以便在农村和偏远地区进行培训。这种混合方法确保了一个有效且基于证据的培训项目。该研究展示了用于增强maxSIMdrone培训项目的EDVC方法,可实现有效的院外CA护理。该项目纳入了参与者的反馈,提高了AED使用方面的知识和技术。它有可能改善资源有限的农村和偏远地区的患者结局。