Holzman R S, Cooper J B, Gaba D M, Philip J H, Small S D, Feinstein D
Department of Anaesthesia, Harvard Medical School, Boston, MA, USA.
J Clin Anesth. 1995 Dec;7(8):675-87. doi: 10.1016/0952-8180(95)00146-8.
Little formal training is provided in anesthesiology residency programs to help acquire, develop, and practice skills in resource management and decision making during crises in practice. Using anesthesia crisis resource management (ACRM) principles developed at another institution, 68 anesthesiologists and 4 nurse-anesthetists participated in an ACRM training course held over a 2 and a half-month period. The anesthesia environment was recreated in a real operating room, with standard equipment and simulations requiring actual performance of clinical interventions. Scenarios included overdose of inhalation anesthetic, oxygen source failure, cardiac arrest, malignant hyperthermia, tension pneumothorax, and complete power failure. A detailed questionnaire was administered following the debriefing and completed by all participants, documenting their immediate impressions. Participants rated themselves as having performed well in the simulator. Senior attendings and residents rated themselves more highly than did their junior counterparts. The potential benefit of this course for anesthesiologists to practice anesthesia more safely in a controlled exercise environment, was rated highly by both groups. Over one half of respondents in all categories felt that the course should be taken once every 12 months; another third of each group felt that the course should be taken once every 24 months. While no senior attendings believed that the course should be taken once every 6 months, approximately 10% of respondents in other categories that it should. Of respondents in the senior and junior attending category, 5% felt the course should never be taken. Although attendings were less favorable than residents in their rating of the value of the course, both groups were still enthusiastic.
麻醉住院医师培训项目中提供的正规培训很少，无法帮助学员在实际操作中的危机情况下掌握、培养和练习资源管理及决策技能。68名麻醉医师和4名麻醉护士依据另一机构制定的麻醉危机资源管理（ACRM）原则，参加了为期两个半月的ACRM培训课程。培训在真实手术室中再现麻醉环境，配备标准设备，并进行需要实际执行临床干预措施的模拟。模拟场景包括吸入麻醉药过量、氧源故障、心脏骤停、恶性高热、张力性气胸和完全停电。在汇报环节后，所有参与者填写了一份详细问卷，记录他们的即时感受。参与者自评在模拟器中的表现良好。高级主治医师和住院医师对自己的评价高于低年资同行。两组人员都高度评价了该课程对麻醉医师在可控的练习环境中更安全地实施麻醉的潜在益处。所有类别中超过一半的受访者认为该课程应每12个月参加一次；每组另外三分之一的受访者认为应每24个月参加一次。虽然没有高级主治医师认为该课程应每6个月参加一次，但其他类别中约10%的受访者持此观点。在高级和低年资主治医师类别中，5%的受访者认为该课程根本不应参加。尽管主治医师对该课程价值的评价不如住院医师，但两组人员仍都很积极。
