Improved procedural performance following a simulation training session may not be transferable to the clinical environment
Improved procedural performance following a simulation training session may not be transferable to the clinical environment
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DOI：
10.1038/jp.2011.141
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发表时间：
2012-07-01
影响因子：
2.9
通讯作者：
Whyte, H. E.
中科院分区：
文献类型：
--
作者：
Finan, E.;Bismilla, Z.;Whyte, H. E.
目的：新生儿气管插管是儿科医生需要的一项挽救生命的操作技能。受训者没有充分的临床经验来培养这种能力。传统的培训包括新生儿复苏计划（NRP），并辅以临床经验。最近，模拟被用于程序技能培训。本研究的目的是检查的影响，模拟会议，教导新生儿插管的技能，通过比较干预前和干预后的性能，并检查转让的技能收购的临床setting.Study设计：第一年的儿科住院医师与NRP培训，但没有以前的新生儿的经验，参加了2小时插管教育会议进行的两个经验丰富的呼吸治疗师。教授技能的各个组成部分，然后在高保真婴儿人体模型上进行练习，同时提供反馈。使用经验证的新生儿插管检查表（CL）和五点总体评定量表（GRS），在干预前和干预后立即使用人体模型评估技能。通过记录成功率、插管时间、CL和GRS评分，对随后8周新生儿重症监护病房（NICU）轮换中进行的临床插管进行评价。还将性能与未接受培训干预的第一年住院医师历史队列进行插管收集的类似数据进行了比较。资料以描述性统计、学生t检定、卡方检定及变异数分析进行分析。平均干预前CL评分为65.4 ± 18%（s.d.）GRS为3 +/-0.7（s.d.）。干预后，表现有所改善，培训后CL评分为93 +/-5%（P <0.0001），GRS为3.92 +/-0.4（P = 0.0003）。这些受训者在随后的NICU轮换期间进行了40次插管，成功率为67.5%，而同期组（NS）为63.15%。然而，在NICU轮换期间，研究受训者的平均CL评分为64.6 +/-20%，显著低于培训后的CL评分（P <0.001），也显著低于历史队列评分82.5 +/-15.4%（P = 0.001）。在干预组中，干预前和现实生活中的CL评分分别为65 +/-18%和64.63%，干预前和现实生活中的GRS分别为3.0 +/-0.7和2.95 +/-0.86，两者之间没有显著差异。干预后，学员的插管技能立即得到显着改善，但这并没有转化为临床表现的改善，表现恢复到基线。事实上，队列组的CL评分显著更高。这些数据表明，模拟环境中的性能改善可能无法转移到临床环境中。他们还支持的证据，虽然同步反馈可能会导致改善性能后立即培训干预，这不会导致改善技能保留的整体。Journal of Perinatology（2012）32，539 - 544; doi：10.1038/jp.2011.141; 2011年9月29日在线发表
Objective: Neonatal intubation is a life-saving procedural skill required by pediatricians. Trainees receive insufficient clinical exposure to develop this competency. Traditional training comprises a Neonatal Resuscitation Program (NRP) complemented by clinical experience. More recently, simulation is being used in procedural skills training. The objective of this study is to examine the impact of a simulation session, which teaches the skill of neonatal intubation by comparing pre- and post-intervention performance, and examining transferability of skill acquisition to the clinical setting.Study Design: First-year pediatric residents with NRP training, but no previous neonatal experience, attended a 2-h intubation education session conducted by two experienced respiratory therapists. Individual components of the skill were taught, followed by practice on a high-fidelity infant mannequin with concurrent feedback. Skills were assessed using a validated neonatal intubation checklist (CL) and a five-point global rating scale (GRS), pre- and immediately post-intervention, using the mannequin. Clinical intubations performed in the subsequent 8-week neonatal intensive-care unit (NICU) rotation were evaluated by documenting success rates, time taken to intubate, and CL and GRS scores. Performance was also compared with similar data collected on intubations performed by a historical cohort of first-year residents who did not receive the training intervention. Data were analyzed using descriptive statistics, Student's t-test and chi(2)-test as appropriate, and analysis of variance.Result: Thirteen residents participated in the educational session. Mean pre-intervention CL score was 65.4 +/- 18% (s.d.) and GRS was 3 +/- 0.7 (s.d.). Performance improved following the intervention with post-training CL score of 93 +/- 5% (P < 0.0001) and GRS of 3.92 +/- 0.4 (P = 0.0003). These trainees performed 40 intubations during their subsequent NICU rotation, with a success rate of 67.5% compared with 63.15% in the cohort group (NS). However, mean CL score for the study trainees during the NICU rotation was 64.6 +/- 20%, significantly lower than their post-training CL score (P < 0.001), and significantly lower than the historical cohort score of 82.5 +/- 15.4% (P = 0.001). In the intervention group, there were no significant differences between the pre-intervention and real-life CL scores of 65 +/- 18% and 64.63 %, respectively, and the pre-intervention and real-life GRS of 3.0 +/- 0.7 and 2.95 +/- 0.86, respectively.Conclusion: Trainees showed significant improvement in intubation skills immediately post intervention, but this did not translate into improved-clinical performance, with performance returning to baseline. In fact, significantly higher CL scores were demonstrated by the cohort group. These data suggest that improved performance in the simulation environment may not be transferable to the clinical setting. They also support the evidence that although concurrent feedback may lead to improved performance immediately post training intervention, this does not result in improved skill retention overall. Journal of Perinatology (2012) 32, 539-544; doi: 10.1038/jp.2011.141; published online 29 September 2011