以模拟教学为主体的整体化儿科体外膜肺技术培训课程效用的评估

Evaluation of the effectiveness of integrated pediatric training course of extracorporeal membrane oxygenation based on simulation teaching

目的评估儿科危重症体外膜肺氧合技术(extracorporeal membrane oxygenation,ECMO)整体化模拟教学课程的效用。方法由复旦大学附属儿科医院ECMO团队建立教学课程,以团队为单位招募学员,提供模拟教学为主的课程,并对团队成员考核成绩及学员反馈进行统计分析。结果自2018年5月开展起,共有22家儿科专科医院或综合性医院儿科,共计132名学员参加本课程的培训。其中男56名(42.4%),45名重症监护病房(intensive care unit,ICU)医生(34.1%),60名ICU护士(45.5%),23名胸外科医生(17.4%),4名麻醉科医生(3.0%)。12名学员(9.1%)曾有过ECMO治疗经历。学员对于课程设置的各个部分有着较高评价,评分均超过4分。对于理论、技能、团队合作和实施ECMO信心的自我评价均有明显提高,有80.3%的学员对课后开展ECMO技术充满信心。学员们的基线理论考核成绩为(55.2±7.6)分,经培训后再次理论考核成绩为(67.1±7.3)分(P<0.001)。以团队为单位的操作考核平均成绩为(70.2±8.2)分,合格率达86.4%。操作考核中技能方面较为突出的问题为:遗漏白蛋白和全血预充(90.9%);非技能方面包括感到紧张(84.8%)、团队合作不够流畅(74.2%)、队长的领导力不够(68.2%)。97.0%和94.7%的学员认为整体培训和模拟教学是课程的亮点。有13家(59.1%)学员单位在课程后成功开展ECMO技术,救治患儿人数达到83例,救治成功率54.2%(45/83)。课程后随访发现,2周左右即有学员单位出现技能水平下降。结论本课程作为ECMO模拟教学的全新尝试,在教学及临床双方面取得一定的效果。同时本研究对于ECMO在儿科领域的发展也起到推动作用。

Objective To evaluate the effectiveness of integrated pediatric training course of extracorporeal membrane oxygenation(ECMO)based on simulation teaching.Methods The instructors of ECMO team of Children′s Hospital of Fudan University developed the teaching curriculum.Team members as a unit were recruited to study simulation-based courses,whose theoretical knowledge,skills and teamwork were assessed,and feedback from the trainees were gathered.Results Since May 2018,22 teams of pediatric specialized hospitals or general hospitals have taken part in our ECMO simulation,with totally 132 participants,including 45 ICU doctors(34.1%),60 ICU nurses(45.5%),23 thoracic surgeons(17.4%)and four anesthesiologists(3.0%).Twelve of them(9.1%)had a little ECMO experience.After training,the trainees had a high evaluation on each part of the course,with average score more than four,of which the theoretical score was lowest.Their self-evaluation on the theory,skills,teamwork and confidence in the implementation of ECMO had been significantly improved.Most(80.3%)of the trainees were confident to carry out ECMO in their local hospitals.The trainees′baseline score of theoretical knowledge was 55.2±7.6,and increased to 67.1±7.3 after training(P<0.001).The average teamwork score of the 22 teams was 70.2±8.2,and the qualified rate was up to 86.4%.The most prominent skill problems in operation assessment were no albumin and blood priming(90.9%),non-skill problems were extremely anxious during the overall assessment(84.8%)of the participants,poor team work(74.2%),poor leadership(68.2%).For the feedback of the whole course,97.0%and 94.7%of the trainees thought that integrated training and simulation teaching were the highlights of the course.At present,13(59.1%)units have successfully developed ECMO technology after the course,and the number of children treated has been up to 83,with a survival rate of discharge of 54.2%.However,it was found that the skill level of some participants decreased about 2 weeks after the course.Conclusion As a new attempt of ECMO teaching,this curriculum has achieved certain efficiency in both teaching and clinical practice.At the same time,our study also plays a role in promoting the development of ECMO in pediatrics.