Homan C S, Viccellio P, Thode H C, Fisher W
Department of Emergency Medicine SUNY at Stony Brook, Health Sciences Center University Hospital 11794-7400, USA.
Acad Emerg Med. 1994 Jul-Aug;1(4):382-7. doi: 10.1111/j.1553-2712.1994.tb02649.x.
Emergency-procedure laboratories are not a standardized part of the curriculum for emergency medicine residency programs. The authors evaluated the efficacy of an emergency-procedure laboratory to teach medical students and residents the performance of tube thoracostomy.
A prospective repeated-measures study of tube thoracostomy placement training was performed in an animal-laboratory setting. Participants were six first-postgraduate-year emergency medicine residents and six fourth-year medical students. Each participant was given a written pretest on tube thoracostomies followed by lectures on tube thoracostomy, venous cutdown, peritoneal lavage, and surgical airway. The procedure laboratory, using an anesthetized canine model (20-25 kg), was then conducted. Tube thoracostomies were timed from skin incision to passage of the tube into the thoracic cavity with subsequent tube fogging. Four attempts per participant were documented. Eighteen days later, an identical procedure laboratory was conducted for the same students including a written posttest identical to the pretest.
The written test scores improved for every participant (p < 0.0001). Mean times for procedures completion improved from 121 sec to 39 sec (p = 0<.001) during the first session and improved from 58 sec to 28 sec (p = 0.005) during the second session. Retention of skills was indicated by significant shortening of the time to completion from the first attempt of the first session to that of the second session (121 sec to 58 sec, p = 0.002).
This procedure laboratory, which emphasized skill repetition, led to improvement in procedural speed and retention of tube thoracostomy skills over time. This approach to teaching clinical procedures should be considered for emergency medicine residency programs and for continuing medical education courses that emphasize acquisition of clinical procedural skills.
急诊操作实验室并非急诊医学住院医师培训课程的标准化组成部分。作者评估了一个急诊操作实验室在教授医学生和住院医师进行胸腔闭式引流术方面的效果。
在动物实验室环境中进行了一项关于胸腔闭式引流术放置培训的前瞻性重复测量研究。参与者包括六名急诊医学住院医师第一年学员和六名四年级医学生。每位参与者先进行了关于胸腔闭式引流术的书面预测试，随后接受了关于胸腔闭式引流术、静脉切开术、腹腔灌洗和手术气道的讲座。然后使用麻醉的犬模型（20 - 25千克）进行操作实验室培训。记录从皮肤切开到导管进入胸腔并随后导管通气的胸腔闭式引流术操作时间。记录每位参与者的四次尝试情况。18天后，对相同的学生进行了相同的操作实验室培训，包括与预测试相同的书面后测试。
每位参与者的书面测试成绩均有所提高（p < 0.0001）。在第一阶段，操作完成的平均时间从121秒缩短至39秒（p = 0<.001），在第二阶段从58秒缩短至28秒（p = 0.005）。从第一阶段的第一次尝试到第二阶段的第一次尝试，完成时间显著缩短（121秒至58秒，p = 0.002），表明技能得到了保留。
这个强调技能重复的操作实验室随着时间的推移提高了操作速度并保留了胸腔闭式引流术技能。对于急诊医学住院医师培训项目以及强调临床操作技能获取的继续医学教育课程，应考虑采用这种临床操作教学方法。
