Sparks Freya, Gilbody Nicky, Hilari Katerina
Division of Language and Communication Science, City St Georges, University of London, 1 Myddelton Street, London, EC1R 1UW, UK.
Speech and Language Therapy Department, Barts Health NHS Trust, The Royal London Hospital, Whitechapel, London, E1 1FR, UK.
BMC Med Educ. 2025 Mar 26;25(1):442. doi: 10.1186/s12909-025-06964-8.
Laryngectomy (removal of the larynx, usually due to cancer) results in significant anatomical changes requiring specific clinical skills to safely manage the airway and support altered communication. It is crucial that healthcare professionals understand how to support people with laryngectomy, particularly in emergency care when their usual healthcare teams will not be present. Provision of laryngectomy training is limited. Existing education approaches fail to fully meet the needs of healthcare professionals, which in turn impacts on the provision of intervention to people with laryngectomy. With increasing evidence for simulation in pedagogical literature, this study explores how this approach can be used to support clinical skill education and improve urgent laryngectomy care. The aim of this study was to establish if a simulation-based approach is a feasible method of enhancing healthcare professional knowledge and confidence to provide emergency care to people with laryngectomy.
A simulation-based training programme was piloted with delegates from a range of healthcare professions, over three separate study days. Immersive simulation scenarios were facilitated within a medical simulation centre using a modified SimMan mannequin, specially created models and prosthetics. Post-simulation debriefings were held with a focus on developing clinical skills within a Human Factors approach. In addition, training incorporated a skills-based session and interactive discussion with expert patients. Training was evaluated using pre- and post-course self-evaluation and qualitative feedback. Feasibility outcomes included the percentage of eligible participants who consented to take part, and the number of participants who completed the training.
Twenty-eight multidisciplinary healthcare professionals registered for the training; 26 (93%) attended and completed the training activities as prescribed. Qualitative data indicated that simulation, debrief and skills practice were all perceived as important training aspects. Participants placed particular value on the simulated resuscitation scenario. Self-assessed composite knowledge scores and individual knowledge-item scores increased significantly post-training (p = < 0.001-0.04). Reflective of participants' emphasis on resuscitation, knowledge of post-laryngectomy resuscitation requirements increased significantly post-training (p = < 0.001).
Simulation-based training is a feasible method of clinical skill acquisition for urgent laryngectomy care. Further research is needed to assess whether competence is maintained over time, and whether Human Factors learning generalises to clinical practice. Wider study could incorporate assessment of the impact of the training on people with laryngectomy's experiences of urgent care and potential impact on hospital flow.
喉切除术（通常因癌症切除喉部）会导致显著的解剖结构变化，需要特定的临床技能来安全管理气道并支持改变后的沟通方式。医疗保健专业人员了解如何为喉切除患者提供支持至关重要，尤其是在紧急护理中，此时他们通常的医疗团队可能不在场。喉切除术培训的提供有限。现有的教育方法未能充分满足医疗保健专业人员的需求，这反过来又影响了对喉切除患者的干预措施的提供。随着教学文献中对模拟的证据越来越多，本研究探讨了如何利用这种方法来支持临床技能教育并改善紧急喉切除术护理。本研究的目的是确定基于模拟的方法是否是增强医疗保健专业人员为喉切除患者提供紧急护理的知识和信心的可行方法。
在三个不同的学习日，对来自一系列医疗保健专业的代表进行了基于模拟的培训计划试点。在医学模拟中心使用改良的SimMan人体模型、专门制作的模型和假肢，营造沉浸式模拟场景。模拟后进行了以在人因方法内培养临床技能为重点的汇报。此外，培训还包括一个基于技能的环节以及与专家患者的互动讨论。使用课程前后的自我评估和定性反馈对培训进行评估。可行性结果包括同意参加的合格参与者的百分比以及完成培训的参与者人数。
28名多学科医疗保健专业人员报名参加了培训；26名（93%）按照规定参加并完成了培训活动。定性数据表明，模拟、汇报和技能练习都被视为重要的培训方面。参与者特别重视模拟复苏场景。培训后自我评估的综合知识得分和各个知识项目得分显著提高（p = <0.）。反映参与者对复苏的重视，培训后对喉切除术后复苏要求的知识显著增加（p = <0.）。
基于模拟的培训是获取紧急喉切除术护理临床技能的可行方法。需要进一步研究以评估能力是否能随时间保持，以及人因学习是否能推广到临床实践。更广泛的研究可以纳入对培训对喉切除患者紧急护理体验的影响以及对医院流程的潜在影响的评估。
