Ali J, Cohen R, Adam R, Gana T J, Pierre I, Bedaysie H, Ali E, West U, Winn J
Department of Surgery, The Banting Institute, University of Toronto, 100 College Street, Toronto, Ontario, Canada.
World J Surg. 1996 Oct;20(8):1121-5; discussion 1125-6. doi: 10.1007/s002689900171.
Although the Advanced Trauma Life Support (ATLS) course is now taught internationally, its teaching effectiveness still requires confirmation. The Objective Structured Clinical Examination (OSCE) reliably assesses clinical performance by utilizing standardized patients. An OSCE of eight 15 minute trauma patient stations and two 40 item MCQ tests were used to test the teaching effectiveness of the ATLS program in 32 practicing physicians who applied for an ATLS program in Trinidad and Tobago. The physicians were randomly assigned to an ATLS group (n = 16) that completed the ATLS course and a non-ATLS group (n = 16). Before and after the ATLS course, all physicians completed MCQ tests and trauma OSCE. Mean (+/- SD) OSCE scores (standardized to 20) ranged from 9.8 +/- 1.7 to 10.0 +/- 1.7 and 9.5 +/- 1.8 to 10.8 +/- 1.3 in the ATLS and non-ATLS groups, respectively, prior to the ATLS course (NS). Post-ATLS OSCE scores ranged from 15.9 +/- 1.7 to 17.6 +/- 1.7 in the ATLS group (p < 0.05 compared to pre-ATLS) and 9.5 +/- 1.4 to 10.1 +/- 1.3 in the non-ATLS group, which did not improve their OSCE scores. Adherence to priorities was graded 1 to 7 with the pre-ATLS grades of 1.7 +/- 0.6 (ATLS) and 1.8 +/- 0.7 (non-ATLS) and post-ATLS grades of 6.4 +/- 1.1 (ATLS) and 2.1 +/- 0.6 (non-ATLS). Organized approach to trauma was graded 1 to 5 with pre-ATLS grades of 1.6 +/- 0.5 (ATLS) and 1.7 +/- 0.6 (non-ATLS) and post-ATLS grades of 4.5 +/- 0.6 (ATLS) and 1.9 +/- 0.6 (non-ATLS). Pre-ATLS MCQ scores (%) were similar: 53.1 +/- 8.4 (ATLS) and 57.3 +/- 5.4 (non-ATLS), but post-ATLS scores were greater in the ATLS group: 85.8 +/- 7.1 (ATLS) and 64.2 +/- 3.6 (non-ATLS). Our data support the teaching effectiveness of the ATLS program among practicing physicians as measured by improvement in OSCE scores, adherence to trauma priorities, maintenance of an organized approach to trauma care, and cognitive performance in MCQ examinations.
尽管高级创伤生命支持（ATLS）课程目前在国际上广泛开展，但该课程的教学效果仍有待确认。客观结构化临床考试（OSCE）通过利用标准化病人来可靠地评估临床操作能力。采用由八个15分钟创伤病人站组成的OSCE和两项各含40道题的多项选择题测试，对32名申请参加特立尼达和多巴哥ATLS课程的执业医师，测试ATLS项目的教学效果。这些医师被随机分为完成ATLS课程的ATLS组（n = 16）和非ATLS组（n = 16）。在ATLS课程前后，所有医师均完成多项选择题测试和创伤OSCE。在ATLS课程之前，ATLS组和非ATLS组的平均（±标准差）OSCE分数（标准化为20分）分别为9.8±1.7至10.0±1.7以及9.5±1.8至10.8±1.3（无显著差异）。ATLS课程后，ATLS组的OSCE分数为15.9±1.7至17.6±1.7（与课程前相比，p < 0.05），而非ATLS组为9.5±1.4至10.1±1.3，其OSCE分数未提高。对优先事项的遵循程度按1至7级评分，ATLS课程前ATLS组为1.7±0.6，非ATLS组为1.8±0.7，课程后ATLS组为6.4±1.1，非ATLS组为2.1±0.6。创伤的有条理处理方式按1至5级评分，ATLS课程前ATLS组为1.6±0.5，非ATLS组为1.7±0.6，课程后ATLS组为4.5±0.6，非ATLS组为1.9±0.6。ATLS课程前多项选择题分数（%）相似：ATLS组为53.1±8.4，非ATLS组为57.3±5.4，但课程后ATLS组分数更高：ATLS组为85.8±7.1，非ATLS组为64.2±3.6。我们的数据支持ATLS项目在执业医师中的教学效果，这可通过OSCE分数的提高、对创伤优先事项的遵循、维持有条理的创伤护理方式以及多项选择题考试中的认知表现来衡量。
