麻醉设备故障的处理：以模拟故障评估麻醉住院医师的应对技能

背景手术中麻醉设备故障是；j起麻醉死亡的原因之一，本研究目的在于：（1）设计一套模拟场景以评估麻醉医师应对手术中麻醉设备相关故障的处理能力。（2）评估各研究场景所得结论的可靠性和有效性。方法共设有8个场景来评估麻醉住院医师应对设备故障的能力。有56名住院医师参与这项研究。按接受培训时间分为4组（1年住院医师-4年住院医师）分别参加模拟设备故障评估。每个场景按照处理故障的关键措施及所用的时间评分。结果随着年资的增加，得分也增加。高年资医师（R3和R4组）表现优于低年资医师（R1和R2）。尽管各医师都要经过相同的培训过程，但培训内容逐年加深。8个评估场景的总体得分能很好地反映麻醉住院医师的应对技能（无论按关键措施还是按完成所需时间来评分）。结论模拟手术中突发设备故障情况能较好反映麻醉住院医师的应对技能。所用多种场景评估能有效反映个体处理危机的水平。按年资得到的总结性结果可作为评价目前住院医师技能培训成效的参考。

BACKGROUND： Intraoperative anesthesia equipment failures are a cause of anesthetic morbidity. Our purpose in this study was 1 ） to design a set of simulated scenarios that measure skill in managing intraoperafive equipmentrelated errors and 2） to evaluate the reliability and validity of the measures from this multiple scenario assessment. METH- ODS： Eight intraoperative scenarios were created to test anesthesia residents＇skills in managing a number of equipmentrelated failures. Fifty-six resident physicians, divided into four groups based on their training year （Resident 1 - Resident 4）, participated in the individual simulation-based assessment of equipment-related failures. The score for each scenario was gen- erated by a checklist of key actions relevant to each scenario and time to complete these actions. RESULTS： The residents＇ scores, on average, improved with increased level of training. The more senior residents （R3 and R4） performed better than more junior residents （R1 and R2）. Despite similar training background, there was a wide range of skill among the residents within each training year. The summary score on the eight scenario assessments, measured by either the key actions or the time required to manage the events, yielded a reliable estimate of a resident＇s skill in managing these simulated equipment failures. DISCUSSION： Anesthesia residents＇ performances could be reliably evaluated using a set of simulated intraopera- five equipment problems. This multiple scenario assessment was an effective method to evaluate individual performance. The summary results, by training year, could be used to determine how successful current instructional methods are for acquiring skill.