Teaching First or Teaching Last: Does the Timing Matter in Simulation-Based Surgical Scenarios?
Teaching First or Teaching Last: Does the Timing Matter in Simulation-Based Surgical Scenarios?
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DOI：
10.1016/j.jsurg.2010.05.001
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发表时间：
2010-11-01
影响因子：
2.9
通讯作者：
Farley, David R.
中科院分区：
文献类型：
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作者：
Zendejas, Benjamin;Cook, David A.;Farley, David R.
目的：在基于模拟的场景中，最佳的教学时间尚不清楚。我们试图确定不同的教学时间，无论是在模拟之前（先教）还是之后（最后教），如何影响外科实习生的知识成果。设计：我们进行了一项测试前/测试后交叉研究，在这项研究中，四年级医学生和普通外科住院医师（PGY 1-3）参加了3个教学模块，每个模块在连续的几周内重复两次：内分泌外科（第1和2次）、创伤复苏（第3和4次）和团队训练（第5和6次）。每节课包括3个案例，每个案例包括一个情景简报、一个模拟情景和一个情景后简报。每次上课的时间各不相同。对于教学为先的顺序（第1、4和6次），参与者在每次演示简报期间都会接受讲座。在教学的最后阶段（第2、3和5阶段），受训者在情景后汇报期间接受了相同的讲座。我们分别在每个课程的开始（前测试）和结束（后测试）分别使用课程后调查和相同的10道选择题测试来评估态度和知识。采用重复测量方差分析（ANOVA）分析各组间知识得分的平均差异。结果：49名参与者（11名医学生和38名外科住院医师）至少参加了1次会议，提供了76次观察。平均前测分数相等（p < 0.05）。两组间测前与测后得分变化差异有统计学意义（p = 0.002）。后验平均分为8.24分（标准误差[SE]， 0.29），后验平均分为6.68分（标准误差[SE]， 0.27），后验平均分差为1.56分，95%可信区间为0.79 ~ 2.33分。“最后教学”组和“先教学”组的参与者都优先将汇报和场景分别评为更好的学习体验。结论：在模拟情景后接受指导的参与者的平均知识得分高于在模拟情景前接受指导的参与者。认知超载、压力或激活先验知识都可能作为因果机制参与其中。（外科杂志67:432-438）。(C) 2010年外科项目主任协会。Elsevier Inc.出版。版权所有。)
OBJECTIVE: The optimal timing of instruction in simulation-based scenarios remains unclear. We sought to determine how varying the timing of instruction, either before (teaching first) or after (teaching last) the simulation, affects knowledge outcomes of surgical trainees.DESIGN: We conducted a pretest/posttest crossover study in which fourth-year medical students and general surgery residents (PGY 1-3) participated in 3 instructional modules, each repeated twice in consecutive weeks: endocrine surgery (sessions 1 and 2), trauma resuscitation (sessions 3 and 4), and team training (sessions 5 and 6). Each session comprised 3 cases, each involving a prescenario briefing, a simulated scenario, and a postscenario debriefing. The timing of instruction varied between sessions. For the teaching-first sequence (sessions 1, 4, and 6), participants received a lecture during each prescenario briefing. In the teaching-last sequence (sessions 2, 3, and 5), trainees received an identical lecture during the postscenario debriefings. We assessed attitudes and knowledge using a post-session survey and identical 10-question multiple-choice tests at the start (pretest) and end (posttest) of each session, respectively. The mean differences in knowledge scores between groups were analyzed with repeated-measures analysis of variance (ANOVA).RESULTS: Forty-nine participants (11 medical students and 38 surgical residents) attended at least 1 session, providing 76 observations. Mean pretest scores were equivalent (p > 0.05). The change in scores from pretest to posttest varied between the 2 groups (p = 0.002). The mean posttest score was 8.24 (standard error [SE], 0.29) for the teaching-last group and 6.68 (SE, 0.27) for the teaching-first group (mean difference, 1.56; 95% confidence interval, 0.79-2.33). Both teaching-last and teaching-first group participants preferentially rated debriefings and scenarios, respectively, as the better learning experience.CONCLUSIONS: Participants who received instruction after simulated scenarios achieved higher mean knowledge scores than those who received instruction before simulated scenarios. Cognitive overload, stress, or activation of prior knowledge could all be involved as causal mechanisms. (J Surg 67:432-438. (C) 2010 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)