基于高端模拟人的老年危重急症案例设计与实施

Design and implementation of geriatric critical emergency cases based on high-fidelity simulator

目的探索基于高端模拟人的老年常见危重急症培训案例的设计与实施要点,并总结经验。方法筛选30例真实、典型老年危重急症临床案例,按照标准格式编写病例摘要、任务卡、评分标准,在HAL S3201高端模拟人系统内导入各案例检查化验结果,编写各阶段病情的临床体征与监测参数,依照客观化结构性临床考核原则以及急救通则,将案例考核设计为诊断、鉴别诊断、急诊处置、病情恶化的抢救、病情缓解的后续处置五个模块,并设计相应的考核流程,对解放军总医院第二医学中心接受老年医学培训的42名青年医师开展考核试运行,并进行问卷调查,搜集考核的反馈结果。结果构建包含30例老年常见危重急症的标准化考核案例库,并建立基于高端模拟人的老年危重急症案例考核流程。考核试运行顺利,多数考生认为相比于传统模式,基于高端模拟人的案例考核更加贴近实战,涵盖内容全面,有利于发现自身不足,并提升急救能力。结论基于高端模拟人的老年常见危重急症培训案例与考核流程的设计具有可操作性,有助于提升老年危重症培训效果,值得进一步拓展应用。

Objective To explore the key points of design and implementation of common geriatric critical emergency training cases based on high-fidelity simulator and summarize experience. Methods 30 real and typical geriatric critical emergency cases were selected, and abstracts, task cards and scoring criteria were written according to standard format. The medical data of each case was input into HAL S3201 high-fidelity simulator system. The clinical signs and monitoring parameters of simulator were set to match each clinical stage. According to the rules of Objective Structured Clinical Examination(OSCE) and general principles of first aid, the clinical ability assessment was designed into five modules: diagnosis, differential diagnosis, emergency treatment, rescue in deterioration, and follow-up treatment after remission. Examination procedures were designed according to the assessment. Examination was carried out among 42 young residents who participated in the geriatrics training in the Second Medical Center of Chinese PLA General Hospital, and questionnaire survey was conducted to collect feedback. Results Standardized examination case base which included 30 common geriatric critical emergency cases was constructed, and the examination procedure of common geriatric critical emergency cases based on high-fidelity simulators was established. The examination operated well. Most students considered that compared with traditional mode, case examination based on high-fidelity simulators was closer to reality and covered comprehensive contents, which was conducive to finding their own shortcomings and improving firstaid ability. Conclusion The design of common geriatric critical emergency training cases based on high-fidelity simulator and examination procedures was workable and conducive to promoting the training effect of geriatric critical emergency, and it was worthy of further development and application.