Resta Flavia, Barcella Bruno, Angeli Valentina, Lago Elena, Santaniello Annunziata, Dedato Andrea Simone, Centurioni Clarissa Elisabeth, Regeni Elena, Savastano Simone, Baldi Enrico, Contri Enrico, Maffeis Riccardo, Denti Pietro, Musella Valeria, Schicchi Azzurra, Lonati Davide, Salinaro Francesco, Perlini Stefano, Di Pietro Santi
Emergency Medicine Unit and Emergency Medicine Postgraduate Training Program, Department of Internal Medicine, University of Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy.
Program in Experimental Medicine, University of Pavia, Pavia, Italy.
BMC Med Educ. 2024 Dec 20;24(1):1510. doi: 10.1186/s12909-024-06500-0.
Despite the importance of Ultrasound-guided Regional Anaesthesia (UGRA) in Emergency Medicine (EM), there is significant variability in UGRA training among emergency physicians. We recently developed a one-day (8 h), simulation-based UGRA course, specifically tailored to help emergency physicians to integrate these skills into their clinical practice.
In this pre/post intervention study, emergency physicians attended a course consisting of a 4-hour teaching on background knowledge and a practical part structured as follows: a scanning session on a healthy individual; a needling station with an ex-vivo model (turkey thighs); a simulation-based learning experience on local anaesthetic toxicity (LAST); a session on the UGRA simulator BlockSim™. Participants rated their level of knowledge across several domains of UGRA practice; for this purpose, we used a 5-points Likert scale (from 0 to 4). Participants also rated the perceived utility of the practical sessions. We extrapolated baseline characteristics of participants, and we paired the answers of pre- and post-course questionnaires using Wilcoxon signed-rank test.
Seventy-four emergency physicians across ten Italian regions and Switzerland completed the pre-and post- course questionnaire. Most of them were EM residents (75.68%) who had never performed UGRA. Median self-reported knowledge significantly improved from 1 to 3 in the following domains of UGRA indications: Knowledge of contraindications and UGRA techniques [pre-course 1 (IQR 1-2), post-course 3 (IQR 2-3)]; Equipment and drugs [pre-course 1(IQR 1-1), post-course 3 (IQR2-3)]; LAST recognition [pre-course 1 (IQR 1-2), post-course 3 (IQR 2-4)]; LAST management [pre-course 1 (IQR 1-1,75), post-course 3 (IQR 2-3)] (p < 0.001). A smaller improvement was observed in the domain Knowledge of "sonoanatomy" (from 1 to 2; p < 0.001); this might be due to the fact that a one-hour scanning session on a single healthy volunteer may be insufficient for learners to gain confidence with the relevant sonoanatomy. Most participants rated positively the utility of practical stations (100% for the scanning session; 100% for the ex-vivo station with turkey thigh; 91.8% for the BlockSim™).
The main limitation of this study is that measurements are limited to learners' reaction to learning and self-assessment outcomes. We did not measure the impact of our course on participants' performance in simulated settings, or on their behavior in the clinical setting, or on patient outcomes. The sample size of participants was relatively small, although larger than most published similar studies.
This one-day simulation-based, UGRA course tailored for emergency physicians led to improved participants' self-reported knowledge across several domains of UGRA practice. The course represents an effective educational strategy and can be replicated in other settings for the initial training of emergency physicians in UGRA.
尽管超声引导区域麻醉（UGRA）在急诊医学（EM）中很重要，但急诊医生在UGRA培训方面存在显著差异。我们最近开发了一个为期一天（8小时）的基于模拟的UGRA课程，专门为帮助急诊医生将这些技能融入临床实践而设计。
在这项干预前后研究中，急诊医生参加了一个课程，该课程包括4小时的背景知识教学和如下结构的实践部分：对健康个体的扫描环节；使用离体模型（火鸡大腿）的穿刺练习站；基于模拟的局部麻醉毒性（LAST）学习体验；UGRA模拟器BlockSim™环节。参与者对UGRA实践的几个领域的知识水平进行评分；为此，我们使用了5点李克特量表（从0到4）。参与者还对实践环节的感知效用进行评分。我们推断了参与者的基线特征，并使用威尔科克森符号秩检验对课程前后问卷的答案进行配对。
来自意大利十个地区和瑞士的74名急诊医生完成了课程前后问卷。他们中的大多数是急诊医学住院医师（75.68%），从未进行过UGRA。在UGRA适应症的以下领域，自我报告的知识中位数从1显著提高到3：禁忌症和UGRA技术知识[课前1（四分位距1 - 2），课后3（四分位距2 - 3）]；设备和药物[课前1（四分位距1 - 1），课后3（四分位距2 - 3）]；LAST识别[课前1（四分位距1 - 2），课后3（四分位距2 - 4）]；LAST管理[课前1（四分位距1 - 1.75），课后3（四分位距2 - 3）]（p < 0.001）。在“超声解剖学”知识领域观察到较小的提高（从1到2；p < 0.001）；这可能是因为在一名健康志愿者身上进行的一小时扫描环节可能不足以让学习者对相关超声解剖学有信心。大多数参与者对实践环节的效用给予了积极评价（扫描环节为100%；火鸡大腿离体练习站为100%；BlockSim™为91.8%）。
本研究的主要局限性在于测量仅限于学习者对学习的反应和自我评估结果。我们没有测量我们的课程对参与者在模拟环境中的表现、临床环境中的行为或患者结局的影响。参与者的样本量相对较小，尽管比大多数已发表的类似研究要大。
这个为急诊医生量身定制的为期一天的基于模拟的UGRA课程，使参与者在UGRA实践的几个领域的自我报告知识得到了提高。该课程代表了一种有效的教育策略，可以在其他环境中复制，用于急诊医生UGRA的初始培训。
