Medical Education Unit, School of Medicine, University College Cork, Cork, Ireland
Department of Business Information Systems, Cork University Business School, University College Cork, Cork, Ireland.
BMJ Open. 2023 Aug 3;13(8):e072488. doi: 10.1136/bmjopen-2023-072488.
To determine the effectiveness of proficiency-based progression (PBP) e-learning in training in communication concerning clinically deteriorating patients.
Single-centre multi-arm randomised double-blind controlled trial with three parallel arms.
RANDOMISATION, SETTING AND PARTICIPANTS: A computer-generated program randomised and allocated 120 final year medical students in an Irish University into three trial groups.
Each group completed the standard Identification, Situation, Background, Assessment, Recommendation communication e-learning; group 1 Heath Service Executive course group (HSE) performed this alone; group 2 (PBP) performed additional e-learning using PBP scenarios with expert-determined proficiency benchmarks composed of weighted marking schemes of steps, errors and critical errors cut-offs; group 3 (S) (self-directed, no PBP) performed additional e-learning with identical scenarios to (PBP) without PBP.
Primary analysis was based on 114 students, comparing ability to reach expert-determined predefined proficiency benchmark in standardised low-fidelity simulation assessment, before and after completion of each group's e-learning requirements. Performance was recorded and scored by two independent blinded assessors.
Post-intervention, proficiency in each group in the low-fidelity simulation environment improved with statistically significant difference in proficiency between groups (p<0.001). Proficiency was highest in (PBP) (81.1%, 30/37). Post hoc pairwise comparisons revealed statistically significant differences between (PBP) and self-directed (S) (p<0.001) and (HSE) (p<0.001). No statistically significant difference existed between (S) and (HSE) (p=0.479). Changes in proficiency from pre-intervention to post-intervention were significantly different between the three groups (p=0.001). Post-intervention, an extra 67.6% (25/37) in (PBP) achieved proficiency in the low-fidelity simulation. Post hoc pairwise comparisons revealed statistically significant differences between (PBP) and both (S) (p=0.020) and (HSE) (p<0.001). No statistically significant difference was found between (S) and (HSE) (p=0.156).
PBP e-learning is a more effective way to train in communication concerning clinically deteriorating patients than standard e-learning or e-learning without PBP.
NCT02937597.
确定基于熟练程度进展（PBP）的电子学习在培训与临床恶化患者沟通方面的效果。
单中心多臂随机双盲对照试验，设有三个平行组。
使用爱尔兰大学的计算机生成程序对 120 名即将毕业的医学生进行随机分组和分配。
每个组都完成了标准的识别、情况、背景、评估、建议沟通电子学习；第 1 组（HSE）单独完成了爱尔兰医疗服务行政委员会课程；第 2 组（PBP）使用具有专家确定的熟练程度基准的 PBP 情景进行了额外的电子学习，该基准由步骤、错误和关键错误的加权评分方案组成；第 3 组（S）（自我指导，没有 PBP）使用与 PBP 相同的情景进行了额外的电子学习，但没有 PBP。
主要分析基于 114 名学生，在完成每个组的电子学习要求之前和之后，比较在标准化低保真模拟评估中达到专家确定的预定义熟练程度基准的能力。表现由两名独立的盲评评估者记录和评分。
在干预后，在低保真模拟环境中，每个组的熟练程度都有所提高，且组间熟练程度存在统计学显著差异（p<0.001）。（PBP）组的熟练程度最高（81.1%，30/37）。事后两两比较显示，（PBP）组与自我指导（S）组（p<0.001）和（HSE）组（p<0.001）之间存在统计学显著差异。S 组与 HSE 组之间无统计学显著差异（p=0.479）。三个组间从干预前到干预后的熟练程度变化存在统计学显著差异（p=0.001）。干预后，（PBP）组中有 67.6%（25/37）的学生在低保真模拟中达到了熟练程度。事后两两比较显示，（PBP）组与 S 组（p=0.020）和 HSE 组（p<0.001）之间存在统计学显著差异。S 组与 HSE 组之间无统计学显著差异（p=0.156）。
与标准电子学习或无 PBP 的电子学习相比，基于熟练程度进展的电子学习是培训与临床恶化患者沟通方面的更有效方法。
NCT02937597。
