Use of Simulation-Based Mastery Learning for Thoracentesis to Improve Outcomes

描述(由申请人提供)：基于模拟的掌握学习(SBML)可减少中心静脉置管引起的严重医源性并发症。鉴于医疗程序是困扰3%住院患者的并发症的第二大常见原因，SBML应该应用于所有医疗中心的程序。在学术医院，床边的手术，如胸腔穿刺术(去除胸腔积液)，通常由无人监督的医学实习生执行。传统上，医学实习生学习程序依赖于历史上的“见一、做一、教一”的心态。不幸的是，这种方法使患者在受训人员能够胜任之前就接受了手术。通过使用医学模拟，医学教育人员可以增加受训人员的基本知识和技能，同时确保程序能力，减少患者暴露在不必要的风险中。使用掌握学习模型的医学模拟培训提高了临床技能，并降低了与操作相关的损伤风险。我们的研究小组率先使用这种循证方法来教授医学实习生。掌握学习要求所有学员在完成培训之前展示出统一的高水平技能。这确保了在真正的患者接触之前，在医学模拟器上的能力。这项拟议的研究的目标是调查SBML课程的使用，以提高内科住院医师在为患者进行胸腔手术时的技能。此外，我们将评估这些技能如何影响患者的预后，方法是比较接受过模拟器培训的住院医师和接受过“传统”培训的住院医师进行的胸腔手术。本项目将评估这些总体假设：1)使用掌握学习方法的基于模拟的培训提高了胸腔穿刺术的技能和知识；2)这种方法将促进对所学技能的保留；以及3)改善患者的预后、减少住院时间和医疗成本。具体目标是：1)重新设计胸腔穿刺术程序课程，基于掌握学习模式，使用模拟器、超声波和基于网络的教学指导来培训住院医师；2)测量住院医师技能在课程期间的变化；3)评估受训者在经过掌握学习的正式模拟培训后一年时间内的稳定性；以及4)展示与传统学习方法相比，使用掌握学习程序课程是否减少了胸腔穿刺术的医源性并发症，并通过缩短住院时间和降低成本来提高医疗利用率。这项拟议的研究将证明，SBML显著减少了医生在培训中进行的胸腔手术的医源性并发症和医疗保健成本。这项研究的结果可能会为政策提供参考，要求对所有床边程序使用模拟技术进行基于能力的正式培训。

DESCRIPTION (provided by applicant): Simulation-based mastery learning (SBML) decreases serious iatrogenic complications from central venous catheter insertion. Given medical procedures are the second most common cause of the complications that afflict 3% of hospitalized patients, SBML should be applied to procedures done in all medical centers. In academic hospitals, bedside procedures such as thoracentesis (removal of fluid in the chest) are often performed by unsupervised medical trainees. Traditionally, medical trainees learn procedures relying on the historic "see one, do one, teach one" mentality. Unfortunately, this approach subjects patients to procedures before trainees are competent. Through the use of medical simulation, medical educators can increase the essential knowledge and skills of trainees while assuring procedural competence and reducing patient exposure to undue risk. Medical simulation training using the mastery learning model improves clinical skills and reduces the risk of procedure- associated injury. Our research group pioneered the use of this evidence-based approach for teaching medical trainees. Mastery learning requires that all trainees demonstrate a uniformly high level of skill before training completion. This ensures competence on a medical simulator before actual patient encounters. The goal of the proposed research is to investigate the use of an SBML curriculum to improve internal medicine residents' skills when performing thoracenteses on patients. Additionally, we will evaluate how these skills affect patient outcomes by comparing thoracenteses performed by simulator-trained residents to those who have "traditional" training. This project will evaluate these overall hypotheses: 1) simulation-based training using the mastery learning approach improves thoracentesis skills and knowledge; 2) this methodology will promote retention of the learned skills, and; 3) result in improved patient outcomes, reduced length of stay, and medical costs. Specific aims are: 1) redesign a thoracentesis procedure curriculum, based on the mastery learning model, using simulators, ultrasound, and web-based didactic instruction to train medical residents; 2) measure changes in medical resident skills as they undergo the curriculum, 3) assess the stability of trainees' thoracentesis procedure skills over a one year period following formal simulation training with mastery learning, and; 4) demonstrate whether using the mastery learning procedure curriculum compared to a traditional learning approach decreases iatrogenic complications from thoracentesis and improves healthcare utilization through reductions in length of hospital stay and decreased cost. The proposed study will demonstrate that SBML significantly decreases iatrogenic complications and healthcare costs from thoracenteses performed by physicians in training. Results from this study may inform policy to require formal competency-based training using simulation technology for all bedside procedures.