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通过基于模拟的培训掌握镇静及相关呼吸事件:一项涉及非麻醉科住院医师的随机对照试验

Mastering Sedation and Associated Respiratory Events through Simulation-Based Training: A Randomised Controlled Trial Involving Non-Anaesthesiology Residents.

作者信息

Evain Jean-Noël, Do Tran, Harkouk Hakim, Drolet Pierre, Perron Roger, Georgescu Mihai, Robitaille Arnaud, Tanoubi Issam

机构信息

Medical Simulation Centre, Centre d'Apprentissage des Attitudes et Habiletés Cliniques (CAAHC), Université de Montréal, Pavillon Roger-Gaudry, 2900, Boulevard Édouard-Montpetit, 8e étage, Local N-805, Montréal, QC H3T 1J4, Canada.

出版信息

Eur J Investig Health Psychol Educ. 2024 Feb 23;14(3):463-473. doi: 10.3390/ejihpe14030031.

DOI:10.3390/ejihpe14030031
PMID:38534892
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10969482/
Abstract

Non-anaesthetists commonly administer procedural sedation worldwide, posing the risk of respiratory events that can lead to severe complications. This study aimed to evaluate whether simulation-based learning could lead to enhancements in the clinical proficiency of non-anaesthesiology residents in managing sedation and related respiratory complications. Following the evaluation of baseline clinical performance through a pre-test simulation, 34 residents were randomly allocated to either participate in an innovative simulation-based learning module (intervention group) or view a brief self-learning video (control group). After a one-month period, their clinical performance was assessed again in a post-test simulation involving respiratory arrest during procedural sedation. Two independent assessors rated each resident's performance using video recordings and a scoring tool with scores ranging from 0 to 19/19. The two assessments were averaged for each performance, and the pre- to post-test change was calculated for each resident. While baseline clinical performance was similar, mean (SD) increase in clinical performance was significantly greater in the intervention group than in the control group (+2.4 (1.6) points versus +0.8 (1.3) points, respectively; = 0.002). Our simulation-based learning sedation module resulted in the enhanced management of sedation-related complications compared to baseline and minimal self-learning. Simulation-based medical education may offer an effective approach for equipping non-anaesthesiology residents with essential skills to mitigate risks associated with sedation. (ClinicalTrials.gov identifier: NCT02722226).

摘要

在全球范围内,非麻醉医生普遍实施程序性镇静,这带来了可能导致严重并发症的呼吸事件风险。本研究旨在评估基于模拟的学习是否能提高非麻醉科住院医师管理镇静及相关呼吸并发症的临床能力。通过预测试模拟评估基线临床表现后,34名住院医师被随机分配,要么参加创新的基于模拟的学习模块(干预组),要么观看简短的自学视频(对照组)。一个月后,在涉及程序性镇静期间呼吸骤停的后测试模拟中再次评估他们的临床表现。两名独立评估人员使用录像和评分工具对每位住院医师的表现进行评分,分数范围为0至19/19。对每次表现的两次评估进行平均,并计算每位住院医师从测试前到测试后的变化。虽然基线临床表现相似,但干预组临床能力的平均(标准差)提高显著大于对照组(分别为+2.4(1.6)分和+0.8(1.3)分;P = 0.002)。与基线和最少的自学相比,我们基于模拟的学习镇静模块提高了对镇静相关并发症的管理。基于模拟的医学教育可能为非麻醉科住院医师提供一种有效的方法,使其具备减轻与镇静相关风险的基本技能。(ClinicalTrials.gov标识符:NCT02722226)

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f90/10969482/721299fab29b/ejihpe-14-00031-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f90/10969482/52edd2023770/ejihpe-14-00031-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f90/10969482/a76b85c443ae/ejihpe-14-00031-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f90/10969482/fd0ebcd65977/ejihpe-14-00031-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f90/10969482/721299fab29b/ejihpe-14-00031-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f90/10969482/52edd2023770/ejihpe-14-00031-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f90/10969482/a76b85c443ae/ejihpe-14-00031-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f90/10969482/fd0ebcd65977/ejihpe-14-00031-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5f90/10969482/721299fab29b/ejihpe-14-00031-g004.jpg

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本文引用的文献

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Challenges for interprofessional simulation-based sedation training courses: Mini review.基于模拟的跨专业镇静培训课程面临的挑战:小型综述。
Acute Med Surg. 2023 Dec 27;10(1):e913. doi: 10.1002/ams2.913. eCollection 2023 Jan-Dec.
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Learning patient-centredness with simulated/standardized patients: A realist review: BEME Guide No. 68.以模拟/标准化患者为工具学习以患者为中心的照护:一个现实主义综述:BEME 指南第 68 号。
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BJA Educ. 2022 Jul;22(7):258-264. doi: 10.1016/j.bjae.2022.02.006. Epub 2022 Apr 20.
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High-Fidelity Simulation-Based Education: Description of an Original Crisis Resource Management and Sedation Learning for Dental Surgeons.基于高保真模拟的教育:牙科医生的原始危机资源管理与镇静学习描述
Eur J Investig Health Psychol Educ. 2022 Jan 24;12(2):91-97. doi: 10.3390/ejihpe12020008.
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A mini-review of procedural sedation and analgesia in the emergency department.急诊科程序性镇静与镇痛的小型综述
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Sedation and analgesia in interventional radiology: Where do we stand, where are we heading and why does it matter?介入放射学中的镇静与镇痛:我们处于何处,我们的方向在哪里,以及为什么这很重要?
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Do we really need an anesthesiologist for routine colonoscopy in American Society of Anesthesiologist 1 and 2 patients?对于美国麻醉医师协会分级为1级和2级的患者,进行常规结肠镜检查时我们真的需要一名麻醉医师吗?
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European Society of Anaesthesiology and European Board of Anaesthesiology guidelines for procedural sedation and analgesia in adults.欧洲麻醉学会和欧洲麻醉委员会成人程序镇静和镇痛指南。
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