Simulation Training with Structured Debriefing Improves Residents' Pediatric Disaster Triage Performance
Simulation Training with Structured Debriefing Improves Residents' Pediatric Disaster Triage Performance
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DOI：
10.1017/s1049023x12000775
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发表时间：
2012-06-01
影响因子：
2.2
通讯作者：
Baum, Carl R.
中科院分区：
文献类型：
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作者：
Cicero, Mark X.;Auerbach, Marc A.;Baum, Carl R.
简介：儿科灾难医学 (PDM) 分类是儿科医生的一项重要技能，也是研究生医学教育认证委员会 (ACGME) 住院医师培训的必需组成部分。模拟培训是帮助提供商为高风险、低频事件做好准备的有效工具。汇报是一种以学习者为中心的方法，可以反思学习者的表现，并提高模拟培训的效率。本研究的目的是衡量多受害者模拟在促进学习者获得儿科灾难医学 (PDM) 技能（包括 JumpSTART 分类算法）方面的功效。据推测，多个患者模拟和结构化汇报将提高分诊性能。方法：创建了 10 名受害者的学校枪击场景。受害者由成年志愿者以及对气道操作做出生理反应的高保真度和低保真度模拟人体模型来描绘。学习者是儿科住院医师。预期的分类级别没有透露。教学结束后，学习者完成了第一次模拟。学习者为所有受害者分配分类级别，并以标准化表格记录响应。第一次模拟之后进行了小组结构化汇报。情况汇报使学习者能够回顾受害者并讨论分诊的理由。一周后提出了一个新的 10 名受害者创伤灾难场景，五个月后又提出了第三个场景。在第二个和第三个场景中，学习者再次为多个受害者分配分类级别。 Wilcoxon 符号等级测试用于比较测试前和测试后的分数以及评估前和评估后模拟的表现。结果：共有 53 名学习者完成了教育干预。初始平均分诊表现为 6.9 名患者被准确分诊（范围 = 5-10，SD = 1.3）；结构化汇报后一周，平均分诊表现改善至 8.0/10 名患者（范围 = 5-10，SD = 1.37，P< .0001）；五个月后，分诊持续改善，平均分诊评分为 7.8/10 名患者（SD = 1.33，P< .0001）。对有特殊医疗保健需求的未受伤儿童 (CSHCN) 进行过度分类（67.8% 的学习者在报告前，49.0% 在报告后一周，26.2% 在报告后五个月），对头部受伤、无反应的患者分类不足（41.2% 的学习者在报告前，37.5% 在报告后，11.0%汇报后五个月）是最常见的错误。结论：结构化汇报是 PDM 模拟教育的关键组成部分，可以提高分类准确性；教育干预后五个月，这种改善仍得以维持。未来的课程应强调对 CSHCN 和头部受伤患者的评估。
Introduction: Pediatric disaster medicine (PDM) triage is a vital skill set for pediatricians, and is a required component of residency training by the Accreditation Council for Graduate Medical Education (ACGME). Simulation training is an effective tool for preparing providers for high-stakes, low-frequency events. Debriefing is a learner-centered approach that affords reflection on one's performance, and increases the efficacy of simulation training. The purpose of this study was to measure the efficacy of a multiple-victim simulation in facilitating learners' acquisition of pediatric disaster medicine (PDM) skills, including the JumpSTART triage algorithm. It was hypothesized that multiple patient simulations and a structured debriefing would improve triage performance.Methods: A 10-victim school-shooting scenario was created. Victims were portrayed by adult volunteers, and by high-and low-fidelity simulation manikins that responded physiologically to airway maneuvers. Learners were pediatrics residents. Expected triage levels were not revealed. After a didactic session, learners completed the first simulation. Learners assigned triage levels to all victims, and recorded responses on a standardized form. A group structured debriefing followed the first simulation. The debriefing allowed learners to review the victims and discuss triage rationale. A new 10-victim trauma disaster scenario was presented one week later, and a third scenario was presented five months later. During the second and third scenarios, learners again assigned triage levels to multiple victims. Wilcoxon sign rank tests were used to compare pre-and post-test scores and performance on pre-and post-debriefing simulations.Results: A total of 53 learners completed the educational intervention. Initial mean triage performance was 6.9/10 patients accurately triaged (range = 5-10, SD = 1.3); one week after the structured debriefing, the mean triage performance improved to 8.0/10 patients (range = 5-10, SD = 1.37, P< .0001); five months later, there was maintenance of triage improvement, with a mean triage score of 7.8/10 patients (SD = 1.33, P< .0001). Over-triage of an uninjured child with special health care needs (CSHCN) (67.8% of learners prior to debriefing, 49.0% one week post-debriefing, 26.2% five months postdebriefing) and under-triage of head-injured, unresponsive patients (41.2% of learners pre-debriefing, 37.5% post-debriefing, 11.0% five months post-debriefing) were the most common errors.Conclusions: Structured debriefings are a key component of PDM simulation education, and resulted in improved triage accuracy; the improvement was maintained five months after the educational intervention. Future curricula should emphasize assessment of CSHCN and head-injured patients.