Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit
Simulation-based mastery learning reduces complications during central venous catheter insertion in a medical intensive care unit
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DOI：
10.1097/ccm.0b013e3181a57bc1
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发表时间：
2009-10-01
影响因子：
8.8
通讯作者：
Wayne, Diane B.
中科院分区：
文献类型：
--
作者：
Barsuk, Jeffrey H.;McGaghie, William C.;Wayne, Diane B.
目的：研究基于模拟的MASTHY学习模式对重症监护病房1年内中心静脉置管技能和手术相关并发症发生率的影响。教育干预观察队列研究。地点：三级城市教学医院。对象：103名内科和急诊住院医师。干预：27名住院医师接受传统培训，未接受模拟教育。对这些住院医生在医疗重症监护病房中插入的实际中心静脉导管的并发症和操作安全性进行了调查。随后，76名住院医生完成了颈内静脉和锁骨下中心静脉置管的模拟培训。接受模拟器培训的住院医生被期望达到或超过专家小组设定的最低及格分数，并通过使用中心静脉导管模拟器在技能检查表上的表现来衡量(教育干预前后都有)。经过模拟器培训的住院医生还参加了笔试前后的测试。对接受模拟器培训的住院医生在医疗重症监护病房实际插入的中心静脉导管上的并发症和操作自信心进行了调查。测量和主要结果。接受模拟器培训的住院医生报告说，与传统培训的住院医生相比，在医疗重症监护病房实际插入的中心静脉导管的穿刺量(p<；.0005)、动脉穿刺量(p<；.0005)、导管调整(p=.002)以及更高的成功率(p=.005)都更少。临床技能考试预试，76名住院医师颈内静脉置管达标12例(16%)，锁骨下中心静脉置管达标11例(14%)，平均(颈内静脉)50.6%，标准差23.4%；平均(锁骨下)48.4%，标准差26.8%。模拟训练后，所有住院医师达到或超过最低及格分数：Mean(颈内静脉)=93.9%，SD=10.2；Mean(锁骨下)=91.5%，SD=17.1(p<；0.0005)。笔试成绩由平均70.3%，SD=7.7%提高到84.8%，SD=4.8%(p<；0.0005)。一个基于模拟的掌握学习计划提高了住院医生在模拟中心静脉导管插入方面的技能，并减少了实际患者护理中与中心静脉导管插入有关的并发症。(CRET CARE Med 2009；37：2697-2701)
Objective: To determine the effect of a simulation-based mastery learning model on central venous catheter insertion skill and the prevalence of procedure-related complications in a medical intensive care unit over a 1-yr period.Design. Observational cohort study of an educational intervention.Setting: Tertiary-care urban teaching hospital.Subjects: One hundred three internal medicine and emergency medicine residents.Interventions: Twenty-seven residents were traditionally trained and did not receive simulation-based education. These residents were surveyed regarding complications and procedural seff-confidence on actual central venous catheters they inserted in the medical intensive care unit. Subsequently, 76 residents completed simulation-based training in internal jugular and subclavian central venous catheter insertions. Simulator-trained residents were expected to meet or exceed a minimum passing score set by an expert panel and measured by performance on a skills checklist (given both before and after the educational intervention), using a central venous catheter simulator. Simulator-trained residents also took a written pre- and posttest. Simulator-trained residents were surveyed regarding complications and procedural self-confidence on actual central venous catheters they inserted in the medical intensive care unit.Measurements and Main Results. Simulator-trained residents reported fewer needle passes (p < .0005), arterial punctures (p < .0005), catheter adjustments (p = .002), and higher success rates (p = .005) for actual central venous catheters inserted in the medical intensive care unit than traditionally trained residents. At clinical skills examination pretest, 12 (16%) of 76 simulator-trained residents met the minimum passing score for internal jugular central venous catheter insertion and 11 (14%) of 76 residents met the minimum passing score for subclavian central venous catheter insertion: mean (internal jugular) = 50.6%, SD = 23.4%; mean (subclavian) = 48.4%, So = 26.8%. After simulation training, all residents met or exceeded the minimum passing score at postlest: mean (internal jugular) = 93.9%, SD = 10.2; mean (subclavian) = 91.5%, SD = 17.1 (p < .0005). Written examination performance improved from mean = 70.3%, SD = 7.7%, to 84.8%, SD = 4.8% (p < .0005).Conclusions. A simulation-based mastery learning program increased residents' skills in simulated central venous catheter insertion and decreased complications related to central venous catheter insertions in actual patient care. (Crit Care Med 2009; 37:2697-2701)