Diederich Emily, Lineberry Matthew, Schott Vanessa, Broski Julie, Alsayer Ahmed, Eckels Krista A, Murray Megan J, Huynh William, Thomas Laura A
Division of Pulmonary and Critical Care Medicine, Department of Medicine, University of Kansas School of Medicine, Kansas City, KS, USA.
Zamierowski Institute for Experiential Learning, University of Kansas Medical Center and Health System, Kansas City, KS, USA.
Adv Simul (Lond). 2023 Sep 8;8(1):21. doi: 10.1186/s41077-023-00261-4.
Opportunities to practice procedural skills in the clinical learning environment are decreasing, and faculty time to coach skills is limited, even in simulation-based training. Self-directed learning with hands-on practice early in a procedural skill course might help maximize the benefit of later faculty coaching and clinical experience. However, it may also lead to well-learned errors if learners lack critical guidance. The present study sought to investigate the effects of a hands-on, self-directed "study hall" for central line insertion among first-year residents.
Learner cohorts before vs. after introduction of the study hall (n = 49) were compared on their pre- and post-test performance of key procedural behaviors that were comparable across cohorts, with all learners receiving traditional instructor-led training between tests.
Study hall participants spent a median of 116 min in hands-on practice (range 57-175). They scored higher at pre-test (44% vs. 27%, p = .00; Cohen's d = 0.95) and at post-test (80% vs. 72%, p = .02; Cohen's d = 0.69). A dose-response relationship was found, such that 2 h of study hall were roughly equivalent to the performance improvement seen with four clinical observations or supervised insertions of central lines.
Self-directed, hands-on "study hall" supported improved procedural skill learning in the context of limited faculty availability. Potential additional benefits make the approach worth further experimentation and evaluation.
在临床学习环境中练习操作技能的机会正在减少，而且即使在基于模拟的培训中，教师指导技能的时间也很有限。在操作技能课程早期进行自主实践学习可能有助于最大限度地提高后期教师指导和临床经验的效益。然而，如果学习者缺乏关键指导，这也可能导致形成难以纠正的错误。本研究旨在调查为一年级住院医师开设的关于中心静脉置管的实践操作、自主学习“自习室”的效果。
比较引入自习室前后的学习者队列（n = 49）在关键操作行为的测试前和测试后的表现，这些行为在各队列中具有可比性，所有学习者在两次测试之间都接受传统的教师指导培训。
自习室参与者进行实践操作的时间中位数为116分钟（范围57 - 175分钟）。他们在测试前得分更高（44%对27%，p = 0.00；科恩d值 = 0.95），在测试后也更高（80%对72%，p = 0.02；科恩d值 = 0.69）。发现了一种剂量反应关系，即2小时的自习室学习大致相当于四次临床观察或中心静脉置管的监督操作所带来的操作技能提升。
在教师资源有限的情况下，自主实践的“自习室”有助于提高操作技能学习。潜在的额外益处使这种方法值得进一步试验和评估。
