The Use of Simulation Games and Tabletop Exercises in Disaster Preparedness Training of Emergency Medicine Residents
The Use of Simulation Games and Tabletop Exercises in Disaster Preparedness Training of Emergency Medicine Residents
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模拟游戏和桌面练习在急诊住院医师防灾培训中的应用
DOI：
10.1017/s1049023x19001729
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发表时间：
2019
影响因子：
2.2
通讯作者：
C. García
中科院分区：
文献类型：
--
作者：
L. Rodríguez Rivera;Cynthia Rodriguez Rivera;Alberto Zabala Soler;Rey Pagan Rivera;Luis Rodriguez;C. García
引言：急诊医生在医院灾难应对中起着一线作用，需要适当的培训。
目的：本研究的目的是试点并比较两种应急准备教学干预措施的有效性：第一种采用传统的基于讲座的教学（LEC），第二种利用交互式模拟/基于游戏的教学（SIM）。
方法：在波多黎各庞塞的圣卢卡斯圣公会医院的急诊医学（EM）住院医师培训项目的教学课程中实施了两组随机的前后测设计。住院医师（n = 23）完成了一个侧重于应急准备概念、与灾难相关的临床决策以及医院灾难预案中医生职责的LEC（对照组）或SIM教学模块（单日，1 - 2小时）。在三个不同时间点进行基于知识的多项选择题考试和基于情景的能力考试：干预前一周、培训后即刻以及培训后两周。使用曼 - 惠特尼U检验在每个时间点比较两组之间的考试分数。
结果：教学干预后，在基于知识的考试表现（LEC为81.1%[9.4]对比SIM为74.9%[12.1]；U = 42.50，p = 0.15）和基于情景的考试表现（LEC为80.0%[9.7]对比SIM为80.2%[9.2]；U = 62.00，p = 0.83）方面，LEC组与SIM组之间未发现显著差异，这表明两种教学方法具有相似的有效性。实际上，与基线考试分数相比，培训后即刻基于知识的考试分数提高了两倍，基于情景的考试分数提高了50%以上。培训后两周，相对于SIM组，LEC组基于情景的考试表现显著下降（LEC为63.1%[11.6]对比SIM为75.4%[11.5]；U = 91.50，p = 0.036），这表明与仅接受基于讲座培训的住院医师相比，接受模拟培训的住院医师对基于情景的概念有更好的记忆。
讨论：本研究强调了在急诊医学应急准备课程中纳入模拟培训在提高医生对灾难职责的知识和概念记忆方面的潜在双重价值。
Introduction: Emergency physicians play a frontline role in hospital disaster responses and require appropriate training. Aim: The aim of the current study was to pilot and compare the effectiveness of two emergency preparedness teaching interventions: the first employing traditional lecture-based instruction (LEC) and the second utilizing interactive simulation/game-based teaching (SIM). Methods: A two-group randomized pre- and post-test design was implemented into the didactic curriculum of the Emergency Medicine (EM) Residency Training Program at the San Lucas Episcopal Hospital in Ponce, Puerto Rico. Residents (n=23) completed either a LEC (control) or SIM teaching module (single day, one to two hours) focusing on emergency preparedness concepts, disaster-related clinical decision-making, and physician responsibilities during hospital disaster protocols. Knowledge-based multiple-choice exams and scenario-based competency exams were administered at three different time points: one-week pre-intervention, immediately post-training, and two-weeks post-training. Test scores were compared between groups at each time point using the Mann-Whitney U test. Results: Following the teaching interventions, no significant differences were found between the LEC group versus the SIM group in knowledge-based exam performance (LEC 81.1%[9.4] vs. SIM 74.9%[12.1]; U=42.50, p=0.15) and scenario-based exam performance (LEC 80.0%[9.7] vs. SIM 80.2%[9.2]; U=62.00, p=0.83), suggesting both teaching methods were similarly effective. Indeed, knowledge-based exam scores improved two-fold and scenario-based exam scores improved by over 50% immediately following training relative to baseline exam scores. Two-weeks post-training, a significant decrease in scenario-based exam performance was found in the LEC group relative to the SIM group (LEC 63.1%[11.6] vs. SIM 75.4%[11.5]; U=91.50, p=0.036), suggesting residents who train with simulations show greater retention of scenario-based concepts compared to those who train with lecture-based training alone. Discussion: The current study highlights the potential dual value of incorporating simulation training in EM emergency preparedness curriculums in improving both knowledge and concept retention of physician disaster responsibilities.