Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden; Academic Department of Military Surgery and Trauma, Royal Centre of Defence Medicine (RCDM) Birmingham, United Kingdom.
HQ Army Medical Services Support Unit, Camberley, United Kingdom.
J Surg Educ. 2023 Sep;80(9):1320-1339. doi: 10.1016/j.jsurg.2023.06.018. Epub 2023 Jul 27.
Live anaesthetized animals are used as simulation models to teach techniques in the emergency management of trauma. We aimed to explore how "live tissue training" (LTT) is designed, delivered and evaluated in order to better understand and characterize aspects of educational merit.
A systematic review was performed using PRISMA guidance. A combined approach, involving a 3-stage modified narrative synthesis process and reflexive thematic analysis was used to identify key concepts across the published literature.
Qualitative synthesis of 48 selected articles suggests that LTT is mainly used to teach military and civilian physicians and military medical technicians. The procedures trained vary with the learner population, from simple pre-hospital trauma tasks to advanced operative surgical skills. Many courses use a combination of didactic and practical training, with an animal model used to train practical application of knowledge and procedural skills. Descriptions of the learning interventions are limited, and explicit use of educational theory or pedagogic frameworks were absent within the literature. Four themes were identified regarding aspects of LTT that are valued by learners: "recreating the experience," relating to fidelity and realism; "tick tock" "dynamics of hemorrhage", encompassing the impact of bleeding and urgent pressure to act; "emotional impact" of conducting the training, and "self-efficacy: I believe I can do it."
Thematic analysis of published literature suggests that there may be educational benefit in the use of live tissue models due to time criticality and bleeding, which creates a real-life event. LTT also invokes an emotional response, and learners experience an increase in self-efficacy from participation. We consider that these aspects and associated pedagogy should be addressed when researching and developing alternative simulation modalities, in order to intelligently replace, reduce and refine the use of animals in training practitioners in the emergency management of trauma.
活体麻醉动物被用作模拟模型，以教授创伤急救管理技术。我们旨在探讨“活体组织培训”（LTT）的设计、实施和评估方式，以便更好地理解和描述其教育价值的各个方面。
采用 PRISMA 指南进行系统评价。采用综合方法，包括 3 阶段的改进叙述性综合过程和反思性主题分析，用于识别已发表文献中的关键概念。
对 48 篇选定文章的定性综合表明，LTT 主要用于教授军事和民用医生以及军事医疗技术人员。培训的程序因学习者群体而异，从简单的院前创伤任务到高级手术技能。许多课程采用了理论教学和实践培训的结合，使用动物模型来培训知识和程序技能的实际应用。学习干预措施的描述有限，文献中也没有明确使用教育理论或教学框架。围绕学习者重视的 LTT 方面确定了四个主题：“再现体验”，与保真度和现实性有关；“滴答滴答”“出血的动态”，包括出血和紧急行动的影响；“进行培训的情感影响”，以及“自我效能感：我相信我能做到”。
对已发表文献的主题分析表明，由于时间紧迫性和出血导致的真实生活事件，使用活体组织模型可能具有教育益处。LTT 还会引起情感反应，并且学习者从参与中获得自我效能感的提高。我们认为，在研究和开发替代模拟模式时，应该考虑这些方面和相关的教学法，以便明智地替代、减少和改进动物在创伤急救管理培训实践中的使用。
