规范化培训的麻醉住院医师超声定性胃内容物学习曲线的建立

The construction of standardized training resident＇ learning curves for qualitative ultrasound assessment of gastric content

目的 探讨建立住院医师规范化培训的超声定性胃内容物的学习曲线,确定掌握该技术所需的最少操作例数,为培训课程开发、实践培训和指导教师的客观评估提供参考依据.方法 对10名在浙江省人民医院麻醉科接受规范化培训的住院医师进行教学培训,包括讲座和胃超声人体模拟培训.讲座内容包括文献浏览、胃超声操作具体方法和图像介绍.住院医师分2组,每组5人,共进行6轮操作培训.每名住院医师依次进行超声操作评估并记录每次超声评估结果,每名医师共进行30次超声操作评估.使用随机数字表法随机将志愿者分为空腹组、液体组和固体组,使用累积和方法及曲线拟合构建学习曲线预测模型.结果 参加规范化培训的住院医师超声定性胃内容物总正确率为70.7％（212/300）,超声空腹组总正确率只有59.0％（59/100）,超声液体组和固体组的正确率分别为74.0％（74/100）和79.0％（79/100）;相比空腹组,超声固体组的正确率更高（P＜0.05）.虽然10名住院医师个人学习曲线均超过可接受失败率10％,但是还在不可接受失败率30.0％以内.结论 学习曲线和预测模型不但可以评价住院医师达到学习目标的培训过程,还可以评估新规范化培训项目建立的可行性.经过24次和28次超声操作后,住院医师超声定性胃内容物正确率分别达到90.0％和95.0％,但所需要培训次数较多和培训周期较长,需要进一步确立更方便有效的培训方法.

Objective This study aimed to investigate the construction of standardized training resident＇learning curves for qualitative ultrasound assessment of gastric content and to determine the amount of training a resident would need to achieve competence in the ultrasound technique,so as to provide the reference basis for the training course development,the practice training and formulating the criterion of the qualifications to practice the ultrasound assessment of gastric content.Methods Ten residents underwent a teaching intervention including lectures and an workshop on live models of ultrasound assessment of gastric content.Lectures include reading articles,picture library,and how to perform a systematic qualitative assessment.Ten residents were divided into two groups and five residents were scheduled six training practice per group.Five volunteers were randomly assigned to five different operating areas at training practice.Each resident performed ultrasound sequentially and the results were recorded.Every resident assessed 30 separate sets of data and the results were recorded randomization allocation with random number method was conducted by an independent nurse into ＂empty＂ group,＂clear fluid＂ group and ＂solid＂ group,with ten cases per group.Use the accrual and method to construct an individual learning curve;then learning curves and a predictive model were constructed through the cumulative sum method and nonlinear regression.Results The overall correct diagnosis rate of qualitative ultrasound assessment of gastric content was 70.7% （212/300） in the standardized training of the anesthesia department.The overall correct diagnosis rate was 59% （59/100） in the ＂empty＂ group,and was 74% （74/100） and 79% （79/100） in the ＂clear fluid＂ group and the ＂solid＂ group respectively.When comparing to ＂empty＂ group,the ＂solid＂ group showed a significantly higher failure rate （P〈0.05）.Although the learning curves of the five standardized training residents exceeded the acceptable failure rate of 10%,they were still beyond the cutoff point of unacceptable failure rate of less than 30%.The average number of cases required to achieve 90% and 95% success rates was estimated to be 24 and 28,respectively.Conclusions The learning curve and the predict model could not only evaluate the training process of achieving the learning objectives,but also assess the feasibility of establishing a new standardized training program.This study suggests that 24 and 28 are the average numbers of cases required to achieve 90% and 95% correct rates of qualitative ultrasound assessment of gastric content respectively.As the required number and the long cycle of training,a more convenient and effective training method is needed to be established.