VandenBerg James, Moss Henry, Wechsler Courtney, Johnson Chelsea, McRae Matthew, Sloan Shawn, Dimitrijevski Trifun, Kouyoumjian Sarkis, Kline Jeffrey A, Messman Anne
Department of Emergency Medicine Lewis Katz School of Medicine at Temple University Philadelphia Pennsylvania USA.
Department of Emergency Medicine Wayne State University School of Medicine Detroit Michigan USA.
AEM Educ Train. 2024 Oct 10;8(5):e11029. doi: 10.1002/aet2.11029. eCollection 2024 Oct.
Simulation-based training is commonly used in medical education. However, there is a gap in knowledge regarding best practices in debriefing. We aimed to identify novel solutions to this by adapting video-assisted debriefing (VAD) methodologies used in athletic training. We hypothesized that utilizing VAD would lead to improvements in performance during advanced cardiac life support (ACLS)-based simulations compared to traditional verbal debriefing (VD).
The study was conducted at a single medical school. Participants were fourth-year medical students engaging in ACLS simulation-based training as part of their emergency medicine rotation. After completing an ACLS-based simulation, participants received either VD or VAD and then completed a second simulation scenario. Our primary outcome was ACLS performance, graded by blinded reviewers utilizing a previously developed modified checklist. Secondary outcomes included time from cardiac arrest to initiation of cardiopulmonary resuscitation (CPR) and first defibrillation. Measurements were made before and after the interventional debrief, referred to as pre- and postdebrief. A modified Likert-scale survey was used to subjectively assess the student's overall experience.
Forty-six groups of 275 students were included in the study. Mean ACLS performance score for VD and VAD postdebrief were 85% and 82%, respectively ( = 0.27). Mean time from arrest to CPR initiation for VD and VAD postdebrief groups were 20 and 24 s, respectively ( = 0.46). Mean time from arrest to defibrillation for VD and VAD postdebrief groups were 50 and 59 s, respectively ( = 0.39). For the Likert surveys, 85% or more of participants in both groups indicated that the session was "very helpful" in all survey categories.
VD and VAD both led to improvements in ACLS performance, time to initiation of CPR, and defibrillation among fourth-year medical students. Though postdebrief results were not statistically significantly different by comparison, overall VD led to greater improvement overall across all outcomes.
基于模拟的培训在医学教育中被广泛使用。然而，在总结汇报的最佳实践方面存在知识差距。我们旨在通过采用运动训练中使用的视频辅助总结汇报（VAD）方法来找到解决这一问题的新方案。我们假设与传统的口头总结汇报（VD）相比，使用VAD将导致在基于高级心脏生命支持（ACLS）的模拟中表现有所改善。
该研究在一所医学院进行。参与者是四年级医学生，他们作为急诊医学轮转的一部分参与基于ACLS模拟的培训。完成基于ACLS的模拟后，参与者接受VD或VAD，然后完成第二个模拟场景。我们的主要结果是ACLS表现，由不知情的评审人员使用先前制定的修改后的检查表进行评分。次要结果包括从心脏骤停到开始心肺复苏（CPR）和首次除颤的时间。在干预性总结汇报之前和之后进行测量，分别称为汇报前和汇报后。使用修改后的李克特量表调查来主观评估学生的总体体验。
该研究纳入了46组共275名学生。VD组和VAD组汇报后的ACLS平均表现得分分别为85%和82%（P = 0.27）。VD组和VAD组汇报后从心脏骤停到开始CPR的平均时间分别为20秒和24秒（P = 0.46）。VD组和VAD组汇报后从心脏骤停到除颤的平均时间分别为50秒和59秒（P = 0.39）。对于李克特调查，两组中85%或更多的参与者表示该课程在所有调查类别中“非常有帮助”。
VD和VAD都使四年级医学生的ACLS表现、开始CPR的时间和除颤情况得到改善。虽然通过比较汇报后的结果在统计学上没有显著差异，但总体而言，VD在所有结果上带来了更大的改善。
