Simulation-based procedural training for pediatric residents: one small step for a program … one giant leap for mankind!
Simulation-based procedural training for pediatric residents: one small step for a program … one giant leap for mankind!
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针对儿科住院医师的基于模拟的程序培训：项目的一小步 — 人类的一大步！
DOI：
10.1097/pcc.0b013e3182a54dbe
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发表时间：
2013
期刊：
影响因子：
--
通讯作者：
Nishisaki,Akira
中科院分区：
文献类型：
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作者：
Conlon,Thomas;Nadkarni,Vinay;Nishisaki,Akira
回答关于“我们的培训如何转化为对真实患者的床边表现”的问题？在基于模拟的教育研究中引入了从工作台(即模拟实验室)到床边的转化性研究的概念(11，12)。T1级别的结果是对模拟环境中的学科知识、技能和态度的衡量。T2水平的结果是床边的过程措施。临床环境中的能力评估就是一个很好的例子。T3水平的结果是患者和队列水平的结果。医学教育文献表明，只有不到5%的研究报告了患者的结果(13)，考虑到投入到改善患者结果的教育倡议上的时间和财政资源，这是一个惊人的发现。一项荟萃分析显示，与真实的临床环境评估相比，教育干预措施(即技能的提高)在模拟评估中的效果更大(14)。基于这一发现，我们推测T1结果需要非常有效才能转移到T2和T3结果。值得注意的是，目前的研究清楚地表明，提供者对柯克帕特里克模型(T1结果之一)的信心或反应水平通常与客观测量的结果无关。因此，应该非常仔细地解释这些反应结果。总而言之，Thomas等人(1)证明模拟是一种有价值的教育和研究工具，特别是在向新手提供者介绍新技术(超声波)进行程序培训时，应该受到赞扬。当应用于适当的学习框架以实现设定的教育目标时，模拟提供了一种优化技能获得的工具。为了在临床环境中取得成效，这种教育需要在模拟环境中高度有效。在最初的培训之后，应经常进行临床实践或进修培训，以保持已获得的技能。最后，作为翻译科学的延伸，临床成功和包括并发症在内的患者结果的测量应该得到理想的解决。这项研究是朝着正确方向迈出的一步。下一步，在我们的PICU内改善提供者的表现并优化程序和患者结果，现在是我们要采取的步骤。因此，程序…的一小步也是人类的一大飞跃！
To answer the question about “How does our training translate to bedside performance on real patients?” the concept of translational research from the bench (ie, simulation lab) to the bedside was introduced in simulation-based education research (11, 12). T1 level outcomes are measures of subject knowledge, skills, and attitudes in a simulation environment. T2 level outcomes are process measures at the bedside. Competence assessment in a clinical environment is a good example. T3 level outcomes are patient and cohort level outcomes. The medical education literature suggests that patient outcomes are reported in less than 5% of studies (13), a striking finding given the time and financial resources devoted to educational initiatives to improve patient outcomes. One meta-analysis showed that the effect size of educational interventions (ie, improvement in skills) were larger in simulation assessments compared with real clinical environment assessments (14). Based on this finding, we speculate that T1 outcomes need to be highly effective to enable transfer to T2 and T3 outcomes. Of note, the current study clearly demonstrated that provider’s confidence or reaction level in Kirkpatrick model (one of T1 outcomes) often does not correlate with objectively measured outcomes (15). Thus, those reaction outcomes should be interpreted very carefully. In summary, Thomas et al (1) should be commended on demonstrating that simulation is a valuable educational and research tool, especially when introducing new technology (ultrasound) to novice providers for procedural training. Simulation provides a tool to optimize skill acquisition when applied in an appropriate framework of learning to achieve set educational objectives. To achieve effectiveness in clinical environments, such education needs to be highly effective in simulation environment. This initial training should be followed by frequent clinical practice or refresher training to sustain acquired skills. Finally, as an extension of translational science, the measurement of clinical success and patient outcomes including complications should ideally be addressed. This study is one step in the right direction. Next steps to improve provider performance and optimize procedural and patient outcomes within our PICUs are now ours to take. Thus, one small step for a program… and one giant leap for mankind!