Nielsen Martine Siw, Raben-Levetzau Felix Nicolai, Andersen Steven Arild Wuyts, Wennervaldt Kasper, Konge Lars, Nielsen Anders Bo
SimC-Simulation Center Odense University Hospital Odense Denmark.
Open Patient Data Explorative Network (OPEN) Odense University Hospital Odense Denmark.
AEM Educ Train. 2023 Jul 30;7(4):e10900. doi: 10.1002/aet2.10900. eCollection 2023 Aug.
Emergency cricothyroidotomy is the final approach to establishing a secure airway. The procedure is acute and highly infrequent, making it difficult to achieve and maintain competence in the clinic. Simulation-based training in emergency cricothyroidotomy is effective but it is unknown how often training should be repeated to maintain skills. This study aimed to assess novices' retention of technical skills in emergency cricothyroidotomy after completing SBT.
Novices in emergency cricothyroidotomy completed a structured, simulation-based training program and were randomized to retention tests after 1, 3, or 6 months. Participants completed two emergency cricothyroidotomy tests at end-of-training and follow-up retention testing. Test performances were video recorded and evaluated by two experienced blinded raters using a structured assessment tool. Differences in the performances and the pass/fail rates were analyzed.
Eighty-two medical students from two different Danish universities were included from April 2021 to February 2022. Paired -tests showed skills decay significantly after 1 month (mean loss 6.7 points, < 0.001). The mean loss of points, representing the difference in global score points, from the end-of-training to retention test was 6.7 points (95% confidence interval [CI] 4.5-8.8) for the 1-month group, 8.2 points (95% CI 5.8-10.0) for the 3-months group, and 9.9 points (95% CI 8.1-11.7) for the 6-months group. Six participants in both the 1-month group (23.1%) and the 3-month group (24%) passed the first retention test, but no one in the 6-months group had a passing performance.
Novices' technical skills performance in emergency cricothyroidotomy decay significantly already after 1 month. This initial loss of skill seems to be stable until 3 months, after which there is a further significant loss of skills. Recurring training should be implemented for the benefit of patient safety and outcomes.
紧急环甲膜切开术是建立安全气道的最终手段。该手术是急症手术且极不常见，因此在临床上难以掌握并维持其操作能力。基于模拟的紧急环甲膜切开术培训是有效的，但尚不清楚应多久重复培训一次以维持技能。本研究旨在评估新手在完成基于模拟的培训（SBT）后对紧急环甲膜切开术技术技能的保持情况。
紧急环甲膜切开术新手完成了一个结构化的、基于模拟的培训项目，并在1、3或6个月后随机接受保留测试。参与者在培训结束时和后续保留测试中完成两项紧急环甲膜切开术测试。测试表现通过视频记录，并由两名经验丰富的盲评者使用结构化评估工具进行评估。分析表现和通过/失败率的差异。
2021年4月至2022年2月，纳入了来自丹麦两所不同大学的82名医学生。配对检验显示，1个月后技能显著衰退（平均损失6.7分，<0.001）。从培训结束到保留测试，1个月组代表整体得分差异的平均分数损失为6.7分（95%置信区间[CI]4.5 - 8.8），3个月组为8.2分（95%CI 5.8 - 10.0），6个月组为9.9分（95%CI 8.1 - 11.7）。1个月组和3个月组各有6名参与者（分别为23.1%和24%）通过了首次保留测试，但6个月组无人通过测试。
新手在紧急环甲膜切开术中的技术技能表现1个月后就已显著衰退。这种技能的最初损失似乎在3个月内保持稳定，之后技能进一步显著丧失。为了患者安全和治疗效果，应实施定期培训。
