Use of simulation-based mastery learning to improve polypectomy outcomes

使用基于模拟的掌握学习来改善息肉切除术的结果

• 批准号: 10171579
• 负责人: Jeffrey H Barsuk
• 金额: $ 19.9万
• 依托单位: NORTHWESTERN UNIVERSITY AT CHICAGO
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2024-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10171579
• 关键词: Achievement; Advanced Cardiac Life Support; Affect; Cancer Patient; Catheters; Central Vein; Clinical; Clinical Skills; Colon Carcinoma; Colonic Polyps; Colonoscopy; Colorectal Cancer; Communication; Competence; Competency-Based Education; Development; Educational Curriculum; Educational process of instructing; Ensure; Excision; Exposure to; Fellowship; Frequencies; Gastroenterologist; Gastroenterology; Health Care Costs; Health Personnel; Healthcare; Hospital Charges; Human Resources; Iatrogenesis; Individual; Injury; Institution; Knowledge; Laparoscopic Surgical Procedures; Lead; Learning; Life; Liquid substance; Lung; Maintenance; Measures; Medical; Medical Care Costs; Modeling; Morbidity - disease rate; Operative Surgical Procedures; Outcome; Patient Care; Patients; Performance; Persons; Physicians; Polypectomy; Polyps; Procedures; Provider; Quality of Care; Research; Research Project Grants; Resected; Residual state; Risk; Savings; Site; Specialist; Spinal Puncture; Standardization; Technology; Thoracentesis; Time; Tissues; Training; Training and Education; Variant; Venous; aged; apprenticeship; base; cancer risk; colon cancer screening; colorectal cancer prevention; colorectal cancer screening; design; effectiveness evaluation; high risk; improved; learning outcome; models and simulation; patient safety; screening; simulation; skill acquisition; skills; teacher

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.

项目摘要 执行医疗程序的医疗保健提供者需要保持高水平的技能， 减少患者痛苦并降低总体医疗成本。许多关于程序技能的研究都涉及到 这表明迫切需要改变医生的培训方式。最近 研究还表明，执业多年的主治医生有很大的变异性， 他们的程序技能。具体来说，最近的一项研究评估了胃肠病学家（GI）医生的能力， 在结肠癌筛查的常规结肠镜检查期间从患者身上切除息肉（息肉切除术）， 重点评估成功和完全切除息肉。完全切除息肉至关重要，因为 息肉会在数年内转变为结肠癌。研究结果表明，在GI的技能， 为了充分切除息肉，医生需要对一些患者进行另一次结肠镜检查， 看另一位专家，并导致手术时间增加-所有这些都可能影响患者安全。 医学教育者使用模拟来增加受训者的基本知识和临床技能。这种方法 确保能力，无患者伤害风险。基于模拟的掌握学习（SBML），一种严格的 能力为基础的教育，一再导致提高性能和病人护理质量 跨越各种临床技能（例如，将导管插入大的中央静脉，从肺部排出液体）。 在SBML中，每个学习者必须在模拟环境中展示高水平的技能，然后才能进行实际操作。 病人护理掌握学习导致统一的学习结果，几乎没有变化，并确保只有 有能力的人员提供病人护理。 本研究项目的目的是教参加胃肠病学家使用模拟技术， 掌握学习模式，旨在提高结肠息肉切除技能和患者安全，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 技能的获得和保持，并改善息肉切除的临床结果。 具体目标 目标1：开发旨在改善息肉切除术的基于模拟的掌握学习（SBML）课程 胃肠病学家的技能。 目标2：在6个月和12个月时评估技能获得、技能保留和再培训需求， 胃肠病学家完成SBML息肉切除术课程（a）基于模拟器和（B）实际 视频记录患者息肉切除术。 目的3：评估总手术时间、息肉切除术后部位检查、是否需要重复结肠镜检查，以及 SBML培训前后接受息肉切除术的患者的医院费用 胃肠病学家