Use of simulation-based mastery learning to improve polypectomy outcomes

项目总结 执行医疗程序的医疗保健提供者需要保持高水平的技能 减少患者痛苦，降低整体医疗成本。许多关于程序技能的研究都涉及到 这是对医学实习生的培训，并展示了改变医生培训方式的迫切需要。更近的 研究还表明，执业多年的主治医生有很大的变异性。 在他们的程序技巧上。具体地说，最近的一项研究评估了胃肠病专家(GI)医生的能力 在结肠癌筛查的常规结肠镜检查中，切除患者的息肉(息肉切除)。 重点评估成功和彻底的息肉摘除。彻底切除息肉是至关重要的，因为 息肉可能会在几年后转变为结肠癌。研究结果表明，GI的技能差异很大 医生在适当切除息肉时，需要对一些患者进行另一次结肠镜检查， 看另一位专家，导致手术时间增加-所有这些都会影响患者的安全。 医学教育人员使用模拟来增加学员的基本知识和临床技能。这种方法 确保能力，而不会有伤害病人的风险。基于模拟的精通学习(SBML)，这是一种严格的 以能力为基础的教育，一再提高绩效和患者护理质量 通过各种临床技能(例如，将导管插入大的中心静脉，从肺部引流液体)。 在SBML中，每个学习者必须在模拟环境中展示高水平的技能，然后才能执行实际操作 病人护理。掌握学习产生一致的学习结果，几乎没有变化，并确保只有 有能力的人员提供病人护理。 本研究项目的目标是教授主治医师使用模拟技术和 旨在提高结肠息肉摘除技术和患者安全的掌握学习模式，以及 降低医疗成本。我们的总体假设是SBML提高了医生的知识，促进了 技能的获得和保留，并改善息肉摘除的临床结果。 具体目标 目标1：开发基于模拟的掌握学习(SBML)课程，旨在改进息肉切除术 胃肠病专家的技能。 目标2：评估6个月和12个月的技能获得、技能保留和再培训需求 胃肠病专家完成SBML息肉切除术课程(A)基于模拟器和(B)实际 视频记录的患者息肉切除术。 目标3：评估总手术时间、息肉切除后的部位检查、是否需要重复结肠镜检查，以及 息肉切除术患者接受SBML培训前后的住院费用 胃肠病专家。

PROJECT SUMMARY The maintenance of a high level of skill is required of healthcare providers performing medical procedures to reduce patient suffering and decrease overall medical costs. Many studies of procedural skills have involved medical trainees and demonstrate the crucial need to change the way doctors are trained. More recently studies also have shown that attending physicians who have been practicing for years have a large variability in their procedural skills. Specifically, a recent study evaluated the ability of gastroenterologists (GI) doctors to remove polyps (polypectomy) from patients during routine colonoscopies for colon cancer screening, with a focus on assessing successful and complete polyp removal. Complete polyp removal is critical because polyps can turn into colon cancer over years. Study results demonstrated a wide variability in the skills of GI doctors in adequately removing polyps, which required some patients to undergo another colonoscopy, need to see another specialist, and resulted in increased procedure time—all of which can affect patient safety. Medical educators use simulation to increase trainees' essential knowledge and clinical skills. This approach assures competence without risk of patient harm. Simulation-Based Mastery Learning (SBML), a strict form of competency-based education, has repeatedly resulted in improved performance and patient care quality across a variety of clinical skills (e.g., putting in catheters into large central veins, draining fluid from the lungs). In SBML, each learner must demonstrate a high level of skill in the simulated setting before performing actual patient care. Mastery learning results in uniform learning outcomes with little variability and ensures that only competent personnel deliver patient care. The objective of this research project is to teach attending gastroenterologists using simulation technology and the mastery learning model with the aim of improving colon polyp removal skills and patient safety, and reducing healthcare costs. Our overall hypotheses are that SBML improves physician knowledge, promotes skill acquisition and retention, and improves clinical outcomes of polyp removal. Specific aims Aim 1: Develop a Simulation-based Mastery Learning (SBML) curriculum designed to improve polypectomy skills among gastroenterologists. Aim 2: Evaluate skill acquisition, skill retention, and need for retraining at six and 12 months among gastroenterologists completing the SBML polypectomy curriculum on both (a) simulator-based and (b) actual video-recorded patient polypectomies. Aim 3: Assess total procedure time, post-polypectomy site inspection, need for repeat colonoscopy, and hospital charges for patients receiving a polypectomy before and after the SBML training of gastroenterologists.