麻醉住培医师的认知负荷变化对高保真情景模拟教学效果的影响研究

Impact of changes in cognitive load of anesthesia residents on the effectiveness of high-fidelity scenario simulation teaching

目的探究麻醉住培医师的认知负荷变化对高保真情景模拟教学效果的影响。方法选取2022年2月至11月某三甲医院87名麻醉住培医师为研究对象,按随机数字法将麻醉住培生分为A、B、C组,从麻醉危机资源教学案例库抽取3个病例,采用交叉设计控制培训案例次序,分别对3组麻醉住培医师进行高保真模拟培训,每轮培训由训前指导、模拟教学和培训后总结分析3部分组成。3轮模拟教学后对所有研究对象进行认知负荷、焦虑状态、考核成绩和非技术技能评价。采用SPSS 20.0进行重复测量方差分析和Pearson相关性检验。结果3组住培医师在第一轮模拟培训期间的认知负荷、焦虑评分均高于第二、三轮,第一轮考核成绩[(87.07±5.66)、(88.38±5.41)、(89.07±6.17)]低于第二轮[(95.69±2.29)、(96.10±2.08)、(96.07±2.60)]和第三轮[(96.34±1.45)、(96.38±1.50)、(96.17±1.73)]的考核成绩;第一轮的非技术技能评分[(37.24±7.58)、(38.69±7.27)、(39.24±8.74)]也分别低于第二轮[(46.17±5.55)、(47.07±5.59)、(47.59±6.74)]和第三轮[(47.17±5.21)、(48.48±5.38)、(48.24±6.83)],差异有统计学意义(P<0.05)。在同一模拟案例中,第一轮培训学员的认知负荷和焦虑也高于第二、三轮的学员,考核成绩和非技术技能评分低于第二、三轮,差异有统计学意义(P<0.05)。结论首次情景模拟培训麻醉学员具有较高的认知负荷和焦虑水平,并降低学习效果;多次模拟训练可以减轻学员的认知负荷和焦虑。

Objective To investigate the influence of changes in the cognitive load of anesthesia residents on the teaching effectiveness of high-fidelity scenario simulation.Methods Eighty-seven anesthesia residents in a grade-A tertiary hospital from February to November 2022 were divided into groups A,B,and C according to the random number method.Three cases were selected from the anesthesia crisis resource teaching case library for high-fidelity simulation training for the three groups,respectively,using the crossover design to control the order of the cases.Each round of training consisted of pre-training instruction,simulation teaching,and post-training summarization and analysis.After three rounds of simulation teaching,cognitive load,anxiety status,test scores,and non-technical skills were evaluated for all the study participants.SPSS 20.0 was used to perform analysis of variance with repeated measures and Pearson's correlation analysis.Results All the three groups showed significantly higher cognitive load and anxiety scores during the first-round simulation training than during the second-round and third-round simulation trianing.The test scores were significantly lower in the first round[(87.07±5.66),(88.38±5.41),(89.07±6.17)]than in the second round[(95.69±2.29),(96.10±2.08),(96.07±2.60)]and the third round[(96.34±1.45),(96.38±1.50),(96.17±1.73);all P<0.05].The non-technical skill scores were also significantly lower in the first round[(37.24±7.58),(38.69±7.27),(39.24±8.74)]than in the second round[(46.17±5.55),(47.07±5.59),(47.59±6.74)]and the third round[(47.17±5.21),(48.48±5.38),(48.24±6.83);all P<0.05].For simulations with the same cases,the trainees showed significantly higher cognitive load and anxiety scores and significantly lower test scores and non-technical skill scores in the first round than in the second and third rounds(P<0.05).Conclusions Anesthesia residents have higher levels of cognitive load and anxiety in the first scenario simulation training,which can reduce learning outcomes,and repeated simulation training can reduce trainees'cognitive load and anxiety.