Comparison of Four Methods of Paramedic Continuing Education in the Management of Pediatric Emergencies
Comparison of Four Methods of Paramedic Continuing Education in the Management of Pediatric Emergencies
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DOI：
10.1080/10903127.2021.1916140
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发表时间：
2021-04-21
影响因子：
2.4
通讯作者：
Fales, William D.
中科院分区：
文献类型：
--
作者：
Lammers, Richard L.;Willoughby-Byrwa, Maria J.;Fales, William D.
简介：有限的资源限制了EMS机构致力于儿科急诊继续教育的时间。EMS教师需要有效的，高效的，负担得起的教育策略，这些高风险，低频率的事件。目的：比较4种培训方法对护理人员儿科急诊处理能力的培训效果。研究方法：一个有效的，基于性能的，模拟临床评估模块被用来提供一个基线测量护理人员的复苏技能在三个模拟儿科急诊。针对基线评估发现的缺陷开发了教育模块，包括高级儿科生命支持技能、气道管理、Broselow-Luten胶带（R）的使用、儿科药物剂量计算和药物输送、癫痫发作管理和创伤评估。来自密歇根州五个EMS机构的护理人员被随机分配到四个教育干预组。对照组使用现有的在线继续教育课程。三个实验组在为期2.5年的五个一小时的会议期间接触相同的内容。教学采用高保真度，模拟案例为基础的培训，低保真度模拟培训，或讲座与程序技能实验室，根据组分配。训练后，所有组在4-6个月内使用与基线测试相同的方法进行测试。结果：147例受试者完成了研究。四组之间的基线技能水平没有差异。只有低逼真度模拟训练组显示出组合场景评分的改善（p = 0.0008）。目标技能的分数在高保真组的一个场景中有所提高，在低保真组中有两个，在讲座/实验室组中有一个，在控制组中没有。结论：尽管在三组中发现了培训中所包括的这些技能的改进，但每年两小时的儿科急诊培训不足以产生整体的实质性改进。昂贵的，高保真的模拟器是没有必要的儿科复苏技能的教学护理人员;教学场景使用低保真人体模型和述职似乎是足够的。根据基于案例的模拟评估，在线复习课程提供的内容没有使业绩有任何改善。
Introduction: Finite resources limit the amount of time EMS agencies can dedicate to continuing education in pediatric emergencies. EMS instructors need effective, efficient, and affordable educational strategies for these high-risk, low frequency events. Objective: To compare the effectiveness of four training methods in management of pediatric emergencies for paramedics. Methods: A validated, performance-based, simulated clinical assessment module was used to provide a baseline measurement of paramedics' resuscitation skills during three simulated pediatric emergencies. Educational modules were developed that targeted deficiencies identified by the baseline assessment, including advanced pediatric life support skills, airway management, use of the Broselow-Luten Tape (R), pediatric drug dose calculations and drug delivery, seizure management, and trauma assessment. Paramedics from five EMS agencies in Michigan were randomized to four education intervention groups. The control group used an existing, online, continuing education course. Three experimental groups were exposed to the same content during five, one-hour sessions conducted over 2.5 years. Instruction was delivered using high-fidelity, simulated case-based training, low-fidelity simulation training, or lecture with procedural skills lab, based on group assignment. After the training, all groups were tested within 4-6 months using methods identical to baseline testing. Results: One hundred forty-seven subjects completed the study. There were no differences in baseline skill levels among the four groups. Only the low fidelity simulation training group demonstrated improvement of combined scenario scores (p = 0.0008). Scores for targeted skills improved in one scenario in the high-fidelity group, two in the low-fidelity group, one in the lecture/lab group, and none in the control group. Conclusions: Although improvements in those skills included in the training were found in three groups, two hours of training in pediatric emergencies per year was insufficient to produce a substantial improvement overall. Expensive, high-fidelity simulators were not necessary for teaching pediatric resuscitation skills to paramedics; instructive scenarios using low-fidelity manikins and debriefings appear to be adequate. The content delivered by an online refresher course did not provide any improvement in performance as measured by simulated, case-based assessments.