Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
Department of Medical Education and Skills Laboratory, Hanoi Medical University, Hanoi, Vietnam.
JMIR Med Educ. 2024 Jul 23;10:e47127. doi: 10.2196/47127.
The Primary Trauma Care (PTC) course was originally developed to instruct health care workers in the management of patients with severe injuries in low- and middle-income countries (LMICs) with limited medical resources. PTC has now been taught for more than 25 years. Many studies have demonstrated that the 2-day PTC workshop is useful and informative to frontline health staff and has helped improve knowledge and confidence in trauma management; however, there is little evidence of the effect of the course on changes in clinical practice. The Kirkpatrick model (KM) and the knowledge, attitude, and practice (KAP) model are effective methods to evaluate this question.
The aim of this study was to investigate how the 2-day PTC course impacts the satisfaction, knowledge, and skills of health care workers in 2 Vietnamese hospitals using a conceptual framework incorporating the KAP model and the 4-level KM as evaluation tools.
The PTC course was delivered over 2 days in the emergency departments (EDs) of Thanh Hoa and Ninh Binh hospitals in February and March 2022, respectively. This study followed a prospective pre- and postintervention design. We used validated instruments to assess the participants' satisfaction, knowledge, and skills before, immediately after, and 6 months after course delivery. The Fisher exact test and the Wilcoxon matched-pairs signed rank test were used to compare the percentages and mean scores at the pretest, posttest, and 6-month postcourse follow-up time points among course participants.
A total of 80 health care staff members attended the 2-day PTC course and nearly 100% of the participants were satisfied with the course. At level 2 of the KM (knowledge), the scores on multiple-choice questions and the confidence matrix improved significantly from 60% to 77% and from 59% to 71%, respectively (P<.001), and these improvements were seen in both subgroups (nurses and doctors). The focus of level 3 was on practice, demonstrating a significant incremental change, with scenarios checklist points increasing from a mean of 5.9 (SD 1.9) to 9.0 (SD 0.9) and bedside clinical checklist points increasing from a mean of 5 (SD 1.5) to 8.3 (SD 0.8) (both P<.001). At the 6-month follow-up, the scores for multiple-choice questions, the confidence matrix, and scenarios checklist all remained unchanged, except for the multiple-choice question score in the nurse subgroup (P=.005).
The PTC course undertaken in 2 local hospitals in Vietnam was successful in demonstrating improvements at 3 levels of the KM for ED health care staff. The improvements in the confidence matrix and scenarios checklist were maintained for at least 6 months after the course. PTC courses should be effective in providing and sustaining improvement in knowledge and trauma care practice in other LMICs such as Vietnam.
初级创伤救治（PTC）课程最初是为了指导医疗保健工作者在资源有限的中低收入国家（LMICs）管理严重创伤患者而开发的。PTC 已经教授了超过 25 年。许多研究表明，为期 2 天的 PTC 讲习班对一线卫生人员非常有用且信息丰富，并有助于提高他们对创伤管理的知识和信心；然而，几乎没有证据表明该课程对临床实践的改变有影响。柯克帕特里克模型（KM）和知识、态度和实践（KAP）模型是评估这一问题的有效方法。
本研究旨在使用包含 KAP 模型和 4 级 KM 的概念框架，通过评估越南 2 家医院的卫生保健工作者的满意度、知识和技能，调查为期 2 天的 PTC 课程对其的影响。
2022 年 2 月和 3 月，分别在清化和宁平医院的急诊科（EDs）进行了为期 2 天的 PTC 课程。本研究采用前瞻性干预前后设计。我们使用经过验证的工具在课程开始前、结束时和课程结束后 6 个月评估参与者的满意度、知识和技能。Fisher 确切检验和 Wilcoxon 配对符号秩检验用于比较课程参与者在预测试、后测试和 6 个月课程随访时间点的百分比和平均分数。
共有 80 名卫生保健人员参加了为期 2 天的 PTC 课程，近 100%的参与者对课程感到满意。在 KM 的第 2 级（知识）中，多项选择题和信心矩阵的分数从 60%显著提高到 77%和从 59%提高到 71%，差异均有统计学意义（P<.001），这在两个亚组（护士和医生）中都得到了体现。第 3 级的重点是实践，表明有显著的增量变化，情景检查表分数从平均 5.9（SD 1.9）增加到 9.0（SD 0.9），床边临床检查表分数从平均 5（SD 1.5）增加到 8.3（SD 0.8）（均 P<.001）。在 6 个月的随访中，多项选择题、信心矩阵和情景检查表的分数除了护士亚组的多项选择题分数（P=.005）外，均保持不变。
在越南的 2 家当地医院进行的 PTC 课程在 ED 卫生保健人员的 KM 的 3 个层面上取得了成功，提高了信心矩阵和情景检查表的分数，并至少在课程结束后 6 个月内保持了这些分数。PTC 课程应该能够在像越南这样的其他 LMIC 提供和维持知识和创伤护理实践的改进。
