评价综合模拟对中心静脉置管训练效果的影响：一项对照观察性研究。
Evaluating the effects of comprehensive simulation on central venous catheterization training: a comparative observational study.
机构信息
Department of Industrial Engineering, 307 Engineering Design and Innovation Building, Penn State, University Park, 16801, USA.
Department of Mechanical Engineering, Penn State, University Park, USA.
出版信息
BMC Med Educ. 2024 Jul 10;24(1):745. doi: 10.1186/s12909-024-05661-2.
BACKGROUND
Simulation-based training (SBT) is vital to complex medical procedures such as ultrasound guided central venous catheterization (US-IJCVC), where the experience level of the physician impacts the likelihood of incurring complications. The Dynamic Haptic Robotic Trainer (DHRT) was developed to train residents in CVC as an improvement over manikin trainers, however, the DHRT and manikin trainer both only provide training on one specific portion of CVC, needle insertion. As such, CVC SBT would benefit from more comprehensive training. An extended version of the DHRT was created, the DHRT + , to provide hands-on training and automated feedback on additional steps of CVC. The DHRT + includes a full CVC medical kit, a false vein channel, and a personalized, reactive interface. When used together, the DHRT and DHRT + systems provide comprehensive training on needle insertion and catheter placement for CVC. This study evaluates the impact of the DHRT + on resident self-efficacy and CVC skill gains as compared to training on the DHRT alone.
METHODS
Forty-seven medical residents completed training on the DHRT and 59 residents received comprehensive training on the DHRT and the DHRT + . Each resident filled out a central line self-efficacy (CLSE) survey before and after undergoing training on the simulators. After simulation training, each resident did one full CVC on a manikin while being observed by an expert rater and graded on a US-IJCVC checklist.
RESULTS
For two items on the US-IJCVC checklist, "verbalizing consent" and "aspirating blood through the catheter", the DHRT + group performed significantly better than the DHRT only group. Both training groups showed significant improvements in self-efficacy from before to after training. However, type of training received was a significant predictor for CLSE items "using the proper equipment in the proper order", and "securing the catheter with suture and applying dressing" with the comprehensive training group that received additional training on the DHRT + showing higher post training self-efficacy.
CONCLUSIONS
The integration of comprehensive training into SBT has the potential to improve US-IJCVC education for both learning gains and self-efficacy.
背景
模拟培训（SBT）对于复杂的医疗程序至关重要，例如超声引导中心静脉置管术（US-IJCVC），医生的经验水平会影响发生并发症的可能性。动态触觉机器人训练器（DHRT）的开发是为了培训住院医师进行 CVC，它优于人体模型训练器，然而，DHRT 和人体模型训练器都只提供 CVC 中特定部分的培训，即针插入。因此，CVC SBT 将受益于更全面的培训。创建了 DHRT 的扩展版本，DHRT+，以提供 CVC 的额外步骤的实际操作培训和自动化反馈。DHRT+包括完整的 CVC 医疗套件、假静脉通道以及个性化的、反应性接口。当一起使用时，DHRT 和 DHRT+系统提供了用于 CVC 的针插入和导管放置的全面培训。本研究评估了与单独使用 DHRT 相比，DHRT+对住院医师自我效能和 CVC 技能提升的影响。
方法
47 名住院医师在 DHRT 上完成培训，59 名住院医师在 DHRT 和 DHRT+上接受全面培训。每位住院医师在接受模拟器培训前后填写一份中央线自我效能感（CLSE）调查。在模拟培训后，每位住院医师在人体模型上进行一次完整的 CVC，由一名专家评估员观察并根据 US-IJCVC 检查表进行评分。
结果
在 US-IJCVC 检查表的两项内容上，“口头同意”和“通过导管抽吸血液”，DHRT+组的表现明显优于仅接受 DHRT 组。两个培训组在培训前后的自我效能感都有显著提高。然而，接受的培训类型是 CLSE 项目“按正确的顺序使用正确的设备”和“用缝线固定导管并应用敷料”的重要预测因素，接受了 DHRT+额外培训的综合培训组在培训后表现出更高的自我效能感。
结论
将全面培训纳入 SBT 有可能提高 US-IJCVC 的教育效果，包括学习收益和自我效能感。
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