Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, Minnesota. Division of Pulmonary, Allergy, Critical Care and Sleep Medicine, University of Minnesota, Minneapolis, Minnesota.
Division of Pulmonary and Critical Care Medicine, University of Michigan Medical Center, Ann Arbor, Michigan.
Respir Care. 2024 Oct 25;69(11):1353-1360. doi: 10.4187/respcare.12072.
Training in mechanical ventilation is a key goal in critical care fellowship education. Web-based simulators offer a cost-effective and readily available alternative to traditional on-site simulators. However, it is unclear how effective they are as teaching tools. In this study, we evaluated the test scores of fellows who underwent mechanical ventilation training by using a web-based simulator compared with fellows who used an on-site simulator during a mechanical ventilation course.
This was a nonrandomized controlled trial conducted as part of a mechanical ventilation course that involved 70 first-year critical care fellows. The course was identical except for the simulation technology used. One group of instructors used a traditional on-site simulator, the ASL 5000 Lung Solution ( 39). The second group was instructed in using a web-based simulator, VentSim ( 31). Each fellow completed a pre-course test and a post-course test by using a validated, case-based ventilator waveform examination that consisted of 5 questions with a total possible score of 100. The primary outcome was a comparison of the mean scores on the posttest between the 2 groups. The study was designed as a non-inferiority trial with a predetermined margin of 10 points.
There was no significant difference in the mean ± SD pretest scores between the web-based and the on-site groups (21.1 ± 12.6 and 26.9 ± 13.6 respectively; = .11). The mean ± SD posttest scores were 45.6 ± 25.0 for the web-based simulator and 43.4 ± 16.5 for on-site simulator (mean difference 2.2; one-sided 95% CI -7.0 to ∞; = .02 [non-inferiority confirmed]). Changes in mean ± SD scores (posttest - pretest) were 25.9 ± 20.9 for the web-based simulator and 16.5 ± 15.9 for the on-site simulator (mean difference 9.4, one-sided 95% CI 0.9 to ∞; < .001 [non-inferiority confirmed]).
In the education of first-year critical care fellows on mechanical ventilation waveform analysis, a web-based mechanical ventilation simulator was non-inferior to a traditional on-site mechanical ventilation simulator.
机械通气培训是重症监护专科培训的一个关键目标。基于网络的模拟设备为传统现场模拟设备提供了一种具有成本效益且易于获得的替代方案。然而，目前尚不清楚它们作为教学工具的效果如何。在这项研究中，我们比较了使用基于网络的模拟设备和使用现场模拟设备进行机械通气课程培训的学员的测试成绩，以评估基于网络的模拟设备的效果。
这是一项非随机对照试验，作为机械通气课程的一部分进行，该课程涉及 70 名第一年的重症监护学员。除了使用的模拟技术不同外，课程完全相同。一组教员使用传统的现场模拟设备 ASL 5000 Lung Solution（39），另一组教员则使用基于网络的模拟设备 VentSim（31）。每位学员在完成预课后和课后都要通过一项基于案例的呼吸机波形检查进行测试，该测试共有 5 个问题，总分为 100 分。主要结果是比较两组学员的课后测试平均得分。该研究设计为非劣效性试验，预定的差值为 10 分。
基于网络组和现场组的预测试平均得分（分别为 21.1 ± 12.6 和 26.9 ± 13.6； =.11）无显著差异。基于网络组和现场组的后测试平均得分分别为 45.6 ± 25.0 和 43.4 ± 16.5（平均差值 2.2；单侧 95%CI-7.0 至 ∞； =.02[非劣效性得到确认]）。基于网络组和现场组的平均得分变化（后测试-预测试）分别为 25.9 ± 20.9 和 16.5 ± 15.9（平均差值 9.4，单侧 95%CI0.9 至 ∞； <.001[非劣效性得到确认]）。
在第一年重症监护学员机械通气波形分析的教育中，基于网络的机械通气模拟设备与传统的现场机械通气模拟设备同样有效。
