应用混合模拟技术对急诊医师危重症抢救能力的评价
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摘要
目的以混合模拟技术为基础,探讨急诊医师的危重症抢救能力的现况,评估以胜任力为基础的抢救能力考核的有效性及可行性。方法应用高仿真模拟技术模拟实际临床危重症场景,评估急诊医师危重症临床思维及团队合作沟通能力,比较不同性别、学历、职称、培养年限和工作年限之间的差异。结果参与考核急诊医师共38名,总分为(74. 38±11. 26)分。主治医师组和住院医师组分别是:(78. 66±6. 82)分和(70. 96±12. 07)分,主治医师危重症抢救能力得分显著高于住院医师。住院医师规范化培训第2~3年组和进修医师组,分别是(71. 21±12. 28)分和(79. 63±7. 75)分,进修医师组明显高于住院医师规范化培训第2~3年住院医师组。工作年限1~3年组、4~10年组和≥10年组,分别为(70. 00±12. 14)分、(82. 90±6. 89)分和(76. 04±6. 45)分,工作4~10年医师组明显高于1~3年医师组(P<0. 05)。结论应用混合模拟技术评价急诊住院医师和进修医师的危重症抢救能力,具有较好的有效性及可行性。
Objective To discuss the current situation of rescue capability in critical illness of emergency doctors based on the mixed high-fidelity simulation technology and to evaluate the effectiveness and feasibility of the competency-based rescue capability assessment. Methods The mixed high-fidelity simulation technology was used to simulate the actual clinical critical illness scenarios,and then compare the differences of score between different genders,educational background,professional titles,training years,and work experience. Results A total of 38 emergency doctors participated in the examination. The total score was 74. 38±11. 26. The score of attending physicians group and the residents group were: 78. 66±6. 82 and 70. 96±12. 07 respectively. The score of attending physicians was significantly higher than that of the residents. The score of standardized training resident group and the further education physician group were 71. 21±12. 28 and 79. 63±7. 75 respectively,with that of further education physicians significantly higher than that of the residents. The score of work experience of 1-3 years group,4-10 years group and ≥10 years group were 70. 00±12. 14,82. 90±6. 89 and 76. 04±6. 45 respectively,with that of 4-10 years group was obviously higher than that of 1-3 years group. Conclusions The application of mixed high-fidelity simulation technology to evaluate rescue capability of emergency residents and further education physicians is effective and feasible.
Objective To discuss the current situation of rescue capability in critical illness of emergency doctors based on the mixed high-fidelity simulation technology and to evaluate the effectiveness and feasibility of the competency-based rescue capability assessment. Methods The mixed high-fidelity simulation technology was used to simulate the actual clinical critical illness scenarios,and then compare the differences of score between different genders,educational background,professional titles,training years,and work experience. Results A total of 38 emergency doctors participated in the examination. The total score was 74. 38±11. 26. The score of attending physicians group and the residents group were: 78. 66±6. 82 and 70. 96±12. 07 respectively. The score of attending physicians was significantly higher than that of the residents. The score of standardized training resident group and the further education physician group were 71. 21±12. 28 and 79. 63±7. 75 respectively,with that of further education physicians significantly higher than that of the residents. The score of work experience of 1-3 years group,4-10 years group and ≥10 years group were 70. 00±12. 14,82. 90±6. 89 and 76. 04±6. 45 respectively,with that of 4-10 years group was obviously higher than that of 1-3 years group. Conclusions The application of mixed high-fidelity simulation technology to evaluate rescue capability of emergency residents and further education physicians is effective and feasible.
引文
[1] Colmers-Gray IN,Walsh K,Chan TM. Assessment of emergency medicine residents:a systematic review[J].Can Med Educ J,2017,8:e106-e122.
[2] Epstein RM. Assessment in medical education[J]. N Engl J Med,2007,356:387-396.
[3] Erdogan A,Dong Y,Chen X,et al. Development and validation of clinical performance assessment in simulated medical emergencies:an observational study[J]. BMC Emerg Med,2016,16:4.
[4] Wang EE,Dyne PL,Du H. Systems-based practice:Summary of the 2010 council of emergency medicine residency directors academic assembly consensus workgroup--teaching and evaluating the difficult-to-teach competencies[J]. Acad Emerg Med,2011,18 Suppl 2:S110-S120.
[5] Kessler CS,Leone KA. The current state of core competency assessment in emergency medicine and a future research agenda:recommendations of the working group on assessment of observable learner performance[J]. Acad Emerg Med,2012,19:1354-1359.
[6] Mcgaghie WC,Issenberg SB,Cohen ER,et al. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence[J].Acad Med,2011,86:706-711.
[7] Cheng A,Lockey A,Bhanji F,et al. The use of high-fidelity manikins for advanced life support training-A systematic review and meta-analysis[J]. Resuscitation,2015,93:142-149.
[8] Hall AK,Dagnone JD,Lacroix L,et al. Queen's simulation assessment tool:development and validation of an assessment tool for resuscitation objective structured clinical examination stations in emergency medicine[J]. Simul Healthc,2015,10:98-105.
[9] Connell CJ,Endacott R,Jackman JA,et al. The effectiveness of education in the recognition and management of deteriorating patients:A systematic review[J]. Nurse Educ Today,2016,44:133-145.
[10] Steadman RH,Huang YM. Simulation for quality assurance in training,credentialing and maintenance of certification[J]. Best Pract Res Clin Anaesthesiol,2012,26:3-15.
[11] Von der Heyden M,Meissner K. Simulation in preclinical emergency medicine[J]. Best Pract Res Clin Anaesthesiol,2015,29:61-68.
[12] Hamstra SJ. Keynote address:the focus on competencies and individual learner assessment as emerging themes in medical education research[J]. Acad Emerg Med,2012,19:1336-1343.
[2] Epstein RM. Assessment in medical education[J]. N Engl J Med,2007,356:387-396.
[3] Erdogan A,Dong Y,Chen X,et al. Development and validation of clinical performance assessment in simulated medical emergencies:an observational study[J]. BMC Emerg Med,2016,16:4.
[4] Wang EE,Dyne PL,Du H. Systems-based practice:Summary of the 2010 council of emergency medicine residency directors academic assembly consensus workgroup--teaching and evaluating the difficult-to-teach competencies[J]. Acad Emerg Med,2011,18 Suppl 2:S110-S120.
[5] Kessler CS,Leone KA. The current state of core competency assessment in emergency medicine and a future research agenda:recommendations of the working group on assessment of observable learner performance[J]. Acad Emerg Med,2012,19:1354-1359.
[6] Mcgaghie WC,Issenberg SB,Cohen ER,et al. Does simulation-based medical education with deliberate practice yield better results than traditional clinical education? A meta-analytic comparative review of the evidence[J].Acad Med,2011,86:706-711.
[7] Cheng A,Lockey A,Bhanji F,et al. The use of high-fidelity manikins for advanced life support training-A systematic review and meta-analysis[J]. Resuscitation,2015,93:142-149.
[8] Hall AK,Dagnone JD,Lacroix L,et al. Queen's simulation assessment tool:development and validation of an assessment tool for resuscitation objective structured clinical examination stations in emergency medicine[J]. Simul Healthc,2015,10:98-105.
[9] Connell CJ,Endacott R,Jackman JA,et al. The effectiveness of education in the recognition and management of deteriorating patients:A systematic review[J]. Nurse Educ Today,2016,44:133-145.
[10] Steadman RH,Huang YM. Simulation for quality assurance in training,credentialing and maintenance of certification[J]. Best Pract Res Clin Anaesthesiol,2012,26:3-15.
[11] Von der Heyden M,Meissner K. Simulation in preclinical emergency medicine[J]. Best Pract Res Clin Anaesthesiol,2015,29:61-68.
[12] Hamstra SJ. Keynote address:the focus on competencies and individual learner assessment as emerging themes in medical education research[J]. Acad Emerg Med,2012,19:1336-1343.