情景模拟培训在提高基层医师危重症抢救胜任力中的作用

Effect of Scenario Simulation Training in Improvement of Primary Doctors for the Competence of Critically Ill Emergency Treatment

目的探索情景模拟在提高基层医师危重症抢救岗位胜任力培训中的应用与优势。方法某社区卫生服务中心及所辖卫生服务站点的基层医师共47人纳入本研究。第一阶段从2018年8月1日-12月31日,进行3次单项急危重症抢救技术培训,第二阶段从2019年1月1日-6月31日,进行3次以临床真实病例为基础的情景模拟培训。培训前学员对抢救信心、心理压力和团队配合进行自评,培训后对学员技能掌握运用情况进行考核并记录分数,同时进行问卷调查。结果第一阶段单项技能培训后学员各项技能考核得分较培训前提升,双人CPR得分从(65.22±15.49)分提升至(97.55±1.55)分,P<0.01。在第二阶段模拟培训后,第一次和第二次各项技能考核得分较第一阶段显著降低。二次考核后,双人CPR得分下降至(88.79±3.27)分,P<0.05。但在第三次模拟培训后得分提升至与模拟培训前比较,差异无统计学意义,P>0.05。疾病救治效果评分从开始的(54.47±12.65)分提升至最终的(87.64±4.43)分,P<0.01。通过三次接近临床实际的情景模拟培训后,学员抢救重症患者信心、心理压力和团队配合评分分别从(7.59±1.50)分,(8.35±2.11)分和(7.81±1.29)分提升至(8.73±0.72)分,P<0.05,(6.50±1.39)分,P<0.01和(9.27±0.45)分,P<0.01。结论连续高质量的情景模拟培训可以有效提高基层医师危重症抢救岗位胜任力和接诊重症患者时的信心。

Objective To investigate the application and advantages of scenario simulation in the training of primary doctors for the competence of critically ill emergency treatment.Methods A total of 47 primary doctors from a community health service center and the subbranch service stations in Chaoyang District of Beijing were involved in this study.In the first stage,from Aug 1 st to Dec 31 st 2018,three times of single emergency rescue technical training were conducted.In the second stage,from Jun 1 stto June 31 st 2019,three times of scenario simulation training based on clinical real cases were conducted.Before the training,the trainees made the self-assessment on rescue confidence,psychological pressure and team cooperation.After the training,the trainees’mastery and application of skills were assessed and the scores were recorded.A questionnaire survey was conducted at the same time.Results After the first stage of single skill training,the trainees’skill assessment scores were increased than before,(couple CPR:65.22±15.49 vs.97.55±1.55,P<0.01).After the second stage of simulation training,the scores of the first and second skills assessment were significantly lower than those of the first stage.After second skill assessment,the score of couple CPR decreased to 88.79±3.27,P<0.05,but were gradually improved with the progress of simulation training.The significant difference was disappeared after the third simulation training compared with before the simulation training(P>0.05).The score of disease treatment was significantly improved from 54.47±12.65 to 87.64±4.43(P<0.01)with the simulation training.After three times clinical simulation training,the trainees’confidence in rescuing severe patients,psychological pressure and team tacit recognition were significantly improved from 7.59±1.50,8.35±2.11 and 7.81±1.29 to 8.73±0.72(P<0.05),6.50±1.39(P<0.01)and 9.27±0.45(P<0.01).Conclusion Continuous high-quality scenario simulation training can effectively improve the competency of primary doctors and their confidence in receiving critical ill patients.