Mechanical Ventilation Training During Graduate Medical Education: Perspectives and Review of the Literature.
Mechanical Ventilation Training During Graduate Medical Education: Perspectives and Review of the Literature.
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DOI：
10.4300/jgme-d-18-00828.1
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发表时间：
2019-08-01
影响因子：
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通讯作者：
Seam, Nitin
中科院分区：
文献类型：
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作者：
Keller, Jonathan M;Claar, Dru;Seam, Nitin
背景：机械通气(MV)的管理是危重病人护理的一个重要而复杂的方面。呼吸机的管理策略和技术操作是医生在培训中的关键技能，因为缺乏专业知识可能会导致患者的实质性伤害。目的：我们对描述研究生医学教育中MV教育的文献进行了叙述性回顾，并确定了培训和评估方法的最佳实践。方法：我们在MEDLINE、PubMed和Google Scholar上搜索描述MV教育和评估的英文同行评议文章。我们纳入了2000年至2018年7月期间与GME中MV教育或培训相关的文章。结果：15篇文章符合纳入标准。与麻醉学、急诊医学、普通外科和内科住院医师计划的MV培训相关的研究，以及重症监护医学、儿科重症监护医学以及肺部和重症监护医学的子专业培训。近一半的受访学员对自己接受的MV教育不满意。六项研究评估了教育干预措施，所有研究都使用模拟作为一种教育策略，尽管在内容上存在相当大的异质性。大多数结果通过多项选择知识测试进行评估；只有2项研究评估了教育干预后对实际患者的护理。结论：GME缺乏描述MV教育的信息。现有文献表明，学员对MV培训普遍不满意。最佳实践包括建立特定于MV的学习目标和纳入模拟。下一步研究包括为评估工具制定能力标准和有效性证据，这些工具可以在MV教育课程中使用。
BACKGROUND: Management of mechanical ventilation (MV) is an important and complex aspect of caring for critically ill patients. Management strategies and technical operation of the ventilator are key skills for physicians in training, as lack of expertise can lead to substantial patient harm.OBJECTIVE: We performed a narrative review of the literature describing MV education in graduate medical education (GME) and identified best practices for training and assessment methods.METHODS: We searched MEDLINE, PubMed, and Google Scholar for English-language, peer-reviewed articles describing MV education and assessment. We included articles from 2000 through July 2018 pertaining to MV education or training in GME.RESULTS: Fifteen articles met inclusion criteria. Studies related to MV training in anesthesiology, emergency medicine, general surgery, and internal medicine residency programs, as well as subspecialty training in critical care medicine, pediatric critical care medicine, and pulmonary and critical care medicine. Nearly half of trainees assessed were dissatisfied with their MV education. Six studies evaluated educational interventions, all employing simulation as an educational strategy, although there was considerable heterogeneity in content. Most outcomes were assessed with multiple-choice knowledge testing; only 2 studies evaluated the care of actual patients after an educational intervention.CONCLUSIONS: There is a paucity of information describing MV education in GME. The available literature demonstrates that trainees are generally dissatisfied with MV training. Best practices include establishing MV-specific learning objectives and incorporating simulation. Next research steps include developing competency standards and validity evidence for assessment tools that can be utilized across MV educational curricula.