Simulation Approaches to Ventilator Education: Metrics and Evolution (SAVE-ME)

呼吸机教育的模拟方法：指标和演变 (SAVE-ME)

• 批准号: 8793500
• 负责人: JOHN R HOTCHKISS
• 金额: $ 24.58万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-30 至 2017-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8793500
• 关键词: Simulation; Approaches; Ventilator; Education; Metrics

DESCRIPTION (provided by applicant): Mechanical ventilation (MV) is a cornerstone intervention in modern intensive and emergency care that is used to support hundreds of thousands of individuals each year while they cannot breathe independently. Unfortunately, this lifesaving intervention can cause harm: injudicious ventilator settings can promote lung injury, compromise circulatory stability, produce patient distress, stimulate an inflammatory response, and prolong the period of support required. Such adverse consequences of mechanical ventilation add to the burden of patient suffering, increase healthcare resource utilization, and compromise outcomes. Each year, relatively few practitioners receive detailed training in mechanical ventilation. Consequently, individuals requiring MV may be managed by practitioners with limited or spotty training in this intervention. In addition, the teaching of mechanical ventilation remains primarily a "bedside" exercise more akin to an apprenticeship than a systematic approach to mastery. New learners cannot practice extensively on actual patients, for ethical and practical reasons, and physiologically realistic alternatives are expensive and suffer from limited access. Moreover, exposure of the practitioner to the full spectrum of possible mechanical or physiologic derangements cannot be guaranteed. Those who are taught may not be taught well. Contemporary approaches to the assessment of expertise in mechanical ventilation are ill-suited for defining clinician practice patterns or competence in the context of a potentially harmful intervention for which any patient problem may have many possible solutions, the prevailing physiology is highly dynamic, and the clinician is reasoning in the setting of uncertainty. Similarly, ascertaining the extent to which a practitioner maintains her or his skills is hampered by the lack of clear metrics. We will address these three concerns by: 1. Developing an Internet deployable simulator in which learners confront and manage a carefully constructed population of virtual patients suffering from common cardiopulmonary maladies; 2. Developing and applying state of the art pattern recognition approaches to define practice patterns adopted by experts and novices as they manage virtual patients who require cardiopulmonary support; 3. Comparing the effectiveness of 3 different approaches to training: presentation based, simulation based, and simulation based training that adapts to focus on the learner's "weak areas;" 4. Elucidating the consequences of time away from training and simultaneous management of multiple virtual patients on provider performance. The proposed body of work will produce a cardiopulmonary management training tool deployable as freeware via the Internet, a database of expert and novice practice patterns, information regarding optimal training strategies, and data regarding compromise of provider performance by two relevant issues.

描述(申请人提供)：机械通风(MV)是现代重症和急救护理的基石干预措施，每年用于支持数十万无法独立呼吸的患者。不幸的是，这种挽救生命的干预措施可能会造成伤害：不恰当的呼吸机设置可能会促进肺损伤，损害循环稳定性，产生患者痛苦，刺激炎症反应，并延长所需的支持时间。机械通气的这种不良后果增加了患者的痛苦负担，增加了医疗资源的利用率，并损害了结果。每年，接受机械通风详细培训的从业者相对较少。因此，需要MV的个人可能会由接受过有限或参差不齐的干预培训的从业者进行管理。此外，机械通风的教学基本上仍然是一种“床边”练习，更类似于学徒，而不是系统地掌握。出于伦理和实用的原因，新手不能在实际患者上广泛练习，而且生理上现实的替代方案昂贵，而且获得的机会有限。此外，不能保证从业者暴露在可能的机械或生理紊乱的全部范围内。那些被教育的人可能不会被教得很好。当代评估机械通风专业知识的方法不适合在潜在有害干预的背景下定义临床医生的实践模式或能力，对于这种干预，任何患者问题都可能有许多可能的解决方案，普遍的生理学是高度动态的，临床医生在不确定性的背景下进行推理。同样，由于缺乏明确的衡量标准，确定从业者保持技能的程度也受到阻碍。我们将通过以下方式解决这三个问题：1.开发一个互联网可部署的模拟器，在该模拟器中，学习者面对和管理患有常见心肺疾病的精心构建的虚拟患者群体；2.开发和应用最先进的模式识别方法，以定义专家和新手在管理需要心肺支持的虚拟患者时所采用的练习模式；3.比较3种不同培训方法的有效性：基于演示的、基于模拟的和基于模拟的培训，其适用于关注学习者的“薄弱领域”；4.阐明远离培训和同时管理多个虚拟患者对提供者绩效的影响。拟议的工作将产生一个可通过互联网作为免费软件部署的心肺管理培训工具、一个专家和新手实践模式数据库、关于最佳培训战略的信息以及关于提供者业绩因两个相关问题而受到损害的数据。