O'Leary Fenton
Department of Paediatric Emergency Medicine, The Children's Hospital at Westmead, Westmead, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School Westmead, NSW, Australia.
Paediatr Respir Rev. 2024 Sep;51:2-9. doi: 10.1016/j.prrv.2024.05.002. Epub 2024 May 11.
There is increasing use of clinical Simulation Based Education (SBE) in healthcare due to an increased focus on patient safety, the call for a new training model not based solely on apprenticeship, a desire for standardised educational opportunities that are available on-demand, and a need to practice and hone skills in a controlled environment. SBE programs should be evaluated against Kirkpatrick level 3 or 4 criteria to ensure they improve patient or staff outcomes in the real world. SBE programs have been shown to improve outcomes in neonatology - reductions in hypoxic ischaemic encephalopathy, in brachial plexus injury, rates of school age cerebral palsy, reductions in 24hr mortality and improvements in first pass intubation rates. In paediatrics SBE programs have shown improvements in paediatric cardiac arrest survival, PICU survival, reduced PICU admissions, reduced PICU length of stay and reduced time to critical operations. SBE can improve the non-technical tasks of teamwork, leadership and communication (within the team and with patients and carers). Simulation is a useful tool in Quality and Safety and is used to identify latent safety issues that can be addressed by future programs. In high stakes assessment simulation can be a mode of assessment, however, care needs to be taken to ensure the tool is validated carefully.
由于对患者安全的关注度不断提高、呼吁采用一种不单纯基于学徒制的新型培训模式、希望获得按需提供的标准化教育机会以及需要在可控环境中练习和磨练技能,基于模拟的临床教育(SBE)在医疗保健领域的应用越来越广泛。SBE项目应根据柯克帕特里克三级或四级标准进行评估,以确保它们能在现实世界中改善患者或工作人员的结局。SBE项目已被证明能改善新生儿科的结局——降低缺氧缺血性脑病、臂丛神经损伤、学龄期脑瘫的发生率,降低24小时死亡率并提高首次插管成功率。在儿科,SBE项目已显示出能提高小儿心脏骤停存活率、儿科重症监护病房(PICU)存活率、减少PICU入院人数、缩短PICU住院时间并缩短至关键手术的时间。SBE可以改善团队合作、领导能力和沟通(团队内部以及与患者和护理人员之间)等非技术任务。模拟是质量与安全方面的一种有用工具,可用于识别潜在的安全问题,以便未来的项目加以解决。在高风险评估中,模拟可以作为一种评估方式,然而,需要谨慎确保该工具经过仔细验证。