Improved Patient Safety by Simulator Based Training in Cardiac Surgery

通过心脏手术模拟器培训提高患者安全

• 批准号: 8250796
• 负责人: Richard Feins
• 金额: $ 34.6万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-05-01 至 2014-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8250796
• 关键词: Improved; Patient; Safety; Simulator; Based

DESCRIPTION (provided by applicant): The safety of a surgical patient is closely related to the quality of the surgeon's training. This is particularly true of patients undergoing cardiac surgery, where stakes are high and technical skills are demanding. In most surgical training, technical skills are taught by apprenticeship: residents learn surgery in the operating room, doing parts or all of real operations on real patients. Unfortunately, today's operating room provides insufficient time in which to teach surgery, has no tolerance for the inefficiency inherent in education, offers no chance for deliberate practice of skills, and cannot provide for orchestrated training in how to deal with adverse events. But all of these are essential to the training of a safe surgeon. This study intends to show that training in cardiac surgical techniques can be improved by using modern cardiac surgery simulation technology combined with a rigorous, simulation-based curriculum. This should produce surgeons with better skills and thus ensure safety for patients. This three-year project will determine the effectiveness of using simulator-based training in component tasks and overall procedures based on six modules: three types of cardiac surgical operations and three significant adverse events that can occur during cardiac surgery. The procedures will be taught using a computer-controlled, tissue-based cardiac surgery simulator which has been shown to realistically duplicate the actual patient undergoing cardiac surgery. Eight institutions (University of North Carolina at Chapel Hill, Massachusetts General Hospital, Johns Hopkins University, Vanderbilt University, University of Rochester, Mayo Clinic, Stanford University, and University of Washington) will participate in the study, which will include 16 first-year cardiothoracic residents in each of two consecutive academic years. The first phase of the project (six months) will include development of the simulators and a comprehensive curriculum, and faculty education. The second phase (24 months) will involve simulator-based training and performance assessment of cardiac surgery residents. Each part of the simulation-based training will be evaluated by the instructor, using approved assessment tools. At the end of the training, two independent cardiothoracic surgeons will grade videotaped surgery performed by each simulator-trained resident plus surgery by 16 reference residents. Assessment data from each site will be entered into a study database which will be developed and managed at the University of North Carolina. In the last phase (six months), data will be analyzed by standard methods of analysis. While this proposal will test the hypothesis that cardiac surgery residents can be trained to be safer surgeons by using appropriate simulator-based training, the results should apply equally well across a broad spectrum of surgical practice. PUBLIC HEALTH RELEVANCE: This project will study whether resident physicians who are learning cardiothoracic surgery can become safer surgeons by using surgery simulators to acquire skills before they operate on people. A patient's safety is closely related to the quality of the doctor's training - this is particularly true of patients undergoing heart surgery. The surgical simulators use pig hearts, which closely resemble human hearts. Controlled by a computer, the hearts pump artificial blood, so they seem like living hearts. They are placed in a mannequin to give trainees the feeling that they are operating on a human chest. Residents at eight medical centers will have the opportunity to practice procedures repeatedly on simulators, and to practice responding to unexpected events that might occur during surgery. Their abilities will be compared with those of a group of residents who haven't used the simulator in training.

描述（由申请人提供）：外科病人的安全与外科医生的培训质量密切相关。对于接受心脏手术的患者来说尤其如此，因为这类手术的风险很高，而且对技术技能要求很高。在大多数外科培训中，技术技能都是通过学徒制来教授的：住院医生在手术室里学习外科手术，在真实的病人身上做部分或全部的真实手术。不幸的是，今天的手术室没有足够的时间来教授外科手术，不能容忍教育固有的低效率，没有机会刻意练习技能，也不能提供如何处理不良事件的精心培训。但所有这些都是训练一个安全的外科医生所必需的。本研究旨在表明，利用现代心脏外科模拟技术结合严格的、基于模拟的课程，可以改善心脏外科技术的培训。这将培养出技能更好的外科医生，从而确保患者的安全。这个为期三年的项目将确定在组件任务和基于六个模块的总体程序中使用基于模拟器的培训的有效性：三种类型的心脏外科手术和心脏手术过程中可能发生的三种重大不良事件。这些程序将使用计算机控制的、基于组织的心脏手术模拟器来教授，该模拟器已经被证明可以真实地复制实际接受心脏手术的患者。八所机构（北卡罗来纳大学教堂山分校、马萨诸塞州总医院、约翰霍普金斯大学、范德比尔特大学、罗切斯特大学、梅奥诊所、斯坦福大学和华盛顿大学）将参与这项研究，其中包括16名连续两个学年的心胸科一年级住院医师。项目的第一阶段（6个月）将包括开发模拟器和综合课程，以及教员教育。第二阶段（24个月）将包括基于模拟器的培训和心脏外科住院医生的表现评估。模拟培训的每个部分都将由讲师使用认可的评估工具进行评估。在培训结束时，两名独立的心胸外科医生将对每位接受过模拟器培训的住院医生和16名参考住院医生的手术录像进行评分。每个地点的评估数据将被输入一个研究数据库，该数据库将由北卡罗来纳大学开发和管理。在最后阶段（六个月），数据将通过标准的分析方法进行分析。虽然这一提议将验证心脏外科住院医生可以通过适当的模拟器训练成为更安全的外科医生的假设，但结果应该同样适用于广泛的外科实践。