情景模拟在住院医师气道管理培训中的作用

The role of scenario simulation in the training of airway management in residents

目的气道管理是每个住院医师在工作中都会遭遇到的问题,也是住院医生必须掌握的技能之一-。目前住院医生所接受的气道管理培训相当有限,多局限于气管插管等技术培训,不能满足临床工作的需要。为了让住院医师更好地掌握气道管理的技能,更多地积累气道管理的经验,本研究在既往培训中引人情景模拟培训,并评价教学效果。方法本研究中纳人了上海交通大学医学院附属瑞金医院进行住院医师规范化培训的学员64名,培训中将学员分为2组,21名学员参与听讲案例(传统教学组),43名学员参与情景模拟(情景模拟组),2组学员培训前后均完成课程问卷、理论考试以及气道管理信心自评,培训后所有学员还参与了气管插管操作模拟考核。本研究采用SPSS 20.0统计学软件对数据进行分析处理,正态分布且方差齐的计量资料采用成组1检验,非正态分布的采用秩和检验;计数资料采用x检验,P<0.05为差异有统计学意义。结果培训后,有93.8%的学员认为气道管理课程对他们的医学生涯有帮助,操作模拟考核中有96.9%的学员能在2 min之内完成气管插管。所有学员培训后总体的理论考试成绩(t=-4.663,P<0.001)和气道管理信心自评(t=-11.015,P<0.001)都有显著提高。传统教学组和情景模拟组的学员在气管插管完成时间、理论考试成绩方面均无明显差异,但情景模拟组学员的气道管理信心自评分较传统教学组更高(t=-2.193,P=0.032)。结论本研究表明,在气道管理技能培训的基础上引入情景模拟培训可以帮助学员积累气道管理的经验、树立气道管理的信心,此种教学方式值得在气道管理教学中推广,但需要积累更多情景模拟教学和评估的经验。

Objective Airway management is a common challenge for every resident,which is also one of the essential skills.We added scenario simulation to the training of ainway management and evaluated the results,which might help residents to master the skills and accumulate the experiences of the airway management.M lethods A total of 64 trainees from Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine were involved in the standardized resi-dent training,who were divided into two groups,21 trainees atte nded cases sharing(traditional teaching group),while 43 trainees experienced scenario simulation(simulation group).All the participants finished course questionnaire,tests and the confidence scoring about airway management before and after the course.They also attended the intubation simu-lated-test after the training.SPSS 20.0 was used to process the data.Paired sample t-test,group t-test,rank sum test and Chi-squared test were used to analyze the specific data.P<0.05 was considered as statistically significant.Results After training,93.8%trainees thought the course was quite helpful,and 96.9%trainees could accomplish in-tubation in 2 minutes.The score of theory tests(t=-4.663,P<0.001)and the self-assessment of airway management confidence(t=-11.015,P<0.001)in all trainees before and after training were different.There was no difference in the time-spending of intubation and the scores of theory test in the two groups,however,the trainees in the simulation group had a higher confidence scoring of airway management(t=-2.193,P=0.032).Conclusion The scenario simulation could help trainees to accumulate the experiences and become more confident.The scenario simulation is worth using in the training of airway management,whereas more experiences are needed to accumulate in teaching and assess-ment.