Simulation for Neonatal Endotracheal Intubation Training How Different Is It From Clinical Practice?
Simulation for Neonatal Endotracheal Intubation Training How Different Is It From Clinical Practice?
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DOI：
10.1097/sih.0000000000000551
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发表时间：
2022-02-01
影响因子：
2.4
通讯作者：
Fratantoni, Karen R.
中科院分区：
文献类型：
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作者：
Soghier, Lamia M.;Walsh, Heather A.;Fratantoni, Karen R.
简介新生儿气管插管是一项关键技能，即使在基于模拟的培训(SBT)中，学习者也很难获得。与SBT相比，实习生更喜欢临床体验。这项研究的目的是探索SBT和临床实践在获得新生儿插管技能方面的差异，为人体模型设计提供参考，并提高保真度。方法采用半结构式访谈的基本定性研究方法，确定新入职学员(二、三年级新生儿-围产期医学研究员)及其导师在气管插管技能发展方面的经验。参与者被要求在环境、设备和环境方面将通过SBT学习与临床实践进行比较。他们的反应是用归纳法分析的。结果32名受试者(20名研究员和12名教职员工)表示SBT与真实体验不符。具体地说，模拟器的外观、感觉和功能与真实患者和临床环境的差异足够大，以至于它们不会引起所需的学习反应。临床环境促使情绪高涨，并有一种SBT没有完全捕捉到的混乱气氛。与会者建议，项目在培训的初始阶段使用SBT只是为了获得基本技能，他们为人体模型和SBT课程设计提供了几个解决方案。结论模拟培训不能使新生儿-围产期医学研究员为新生儿插管做好充分准备。应该开发具有独特活动特征的人体模型，如多个呼吸道构型、光滑、分泌物和更柔软的质地。复制临床环境的跨专业性质和压力源的现实环境可能会更好地让学习者为临床实践的复杂性做好准备。
Introduction Neonatal endotracheal intubation is a critical skill that is difficult for learners to acquire even with simulation-based training (SBT). Trainees prefer clinical experiences over SBT. The objective of the study was to explore the differences between SBT and clinical practice in acquiring neonatal intubation skills to inform mannequin design and to improve fidelity. Methods A basic qualitative study using semistructured interviews was conducted to determine the experience of newly competent trainees (second- and third-year neonatal-perinatal medicine fellows) and their instructors in developing intubation skills. Participants were asked to compare learning through SBT with clinical practice in terms of context, equipment, and environment. Their responses were analyzed using an inductive approach. Results Thirty-two participants (20 fellows and 12 faculty) indicated that SBT does not equal the real experience. Specifically, the look, feel, and function of the simulators differ enough from the real patient and the clinical environmental that they do not elicit the desired learning responses. The clinical environment prompted heightened emotions and had a chaotic atmosphere that was not fully captured by SBT. Participants suggested that programs use SBT in the initial phases of training only to gain basic skills and they provided several solutions for mannequin and SBT session design. Conclusions Simulation-based training does not fully prepare neonatal-perinatal medicine fellows for neonatal intubation. Mannequins with unique active features, such as multiple airway configurations, slipperiness, secretions, and softer textures should be developed. Realistic environments that replicate the interprofessional nature and stressors of the clinical environment might better prepare learners for the complexity of clinical practice.