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）减少中心静脉置管引起的严重医源性并发症。鉴于医疗程序是造成并发症的第二大常见原因，3%的住院患者受到并发症的困扰，因此应将SBML应用于所有医疗中心的手术。在学术医院，诸如胸腔穿刺术（取出胸腔内的液体）之类的床边手术通常由无人监督的医学实习生进行。传统上，医学学员学习程序依赖于历史上“看一、做一、教一”的心态。不幸的是，这种方法使患者在受训者有能力之前接受手术。通过使用医学模拟，医学教育工作者可以增加受训者的基本知识和技能，同时确保程序能力并减少患者暴露于不适当的风险。使用精通学习模型的医学模拟训练可以提高临床技能并降低手术相关损伤的风险。我们的研究小组率先将这种循证方法用于医学培训生的教学。掌握式学习要求所有受训人员在培训完成前都表现出统一的高水平技能。这确保了在实际病人接触之前在医疗模拟器上的能力。提出的研究目的是调查使用SBML课程，以提高内科住院医师的技能时，对患者进行胸腹手术。此外，我们将评估这些技能如何影响患者的结果，通过比较由受过模拟器训练的住院医生和那些有“传统”培训的住院医生进行的胸填塞。本项目将评估这些总体假设：1)采用掌握学习方法的基于模拟的训练提高了胸腔穿刺技能和知识；2)这种方法将促进所学技能的保留；3)改善病人的治疗效果，缩短住院时间，降低医疗费用。具体目标是：1)重新设计胸穿刺程序课程，以掌握学习模式为基础，利用模拟器、超声和基于网络的教学指导来培训住院医师；2)测量住院医师在课程学习过程中技能的变化，3)评估学员在经过正式模拟训练和掌握学习后一年的胸穿刺操作技能的稳定性，以及；4)证明与传统学习方法相比，使用掌握学习程序课程是否可以减少胸穿刺的医源性并发症，并通过缩短住院时间和降低成本来提高医疗利用率。拟议的研究将证明，SBML显着减少医源性并发症和医疗保健费用，由培训医师进行胸填塞。这项研究的结果可能会为政策提供信息，要求对所有床边程序使用模拟技术进行正式的基于能力的培训。

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.