模拟医学在麻醉住院医师规范化培训中的应用研究

Application of medical simulation in standardized training of anesthesia residents

目的观察麻醉临床轮转期间,模拟医学对提高麻醉规范化培训教学质量的影响。方法选取2019年新入科的麻醉住培住院医生36名,随机分为对照组和模拟培训组,每组18人。入科后,首先接受1周的入科培训,对照组学员接受无菌技术等知识的学习、观看中心静脉穿刺、气管插管、椎管内穿刺、神经阻滞等操作视频;模拟培训组则在模拟手术室内,采用智能模拟人、操作模块等进行上述培训。轮转1个月后,对学员进行无菌技术、有创操作、爱伤观念等考核,并通过问卷调查进行学员自我评价及带教教师评价。采用SPSS 22.0进行t检验和χ2检验。结果气管插管、深静脉穿刺、椎管内穿刺的操作流程,模拟培训组均优于对照组[(74.16±2.35)vs.(76.05±1.89);(20.22±1.43)vs.(18.61±1.78);(23.17±0.78)vs(.21.11±1.13)];深静脉穿刺和椎管内穿刺的整体得分,模拟培训组优于对照组[(22.78±1.68)vs.(20.83±1.42);(23.28±0.75)vs.(21.83±1.09)];神经阻滞操作手眼协调及操作时间,模拟培训组优于对照组[(15.78±1.38)vs.(14.33±1.51);(15.28±1.30)vs.(13.39±1.40)]。结论模拟医学培训可显著提高麻醉住院医师进入临床轮训的岗位胜任能力,值得进一步推广。

Objective To investigate the effectiveness of medical simulation for improving the quality of standardized residency training during clinical anesthesia rotation.Methods Thirty-six newly admitted anesthesia residents in 2019 were randomly divided into control group and simulation training group,with 18 people in each group.During a week of admission training,the control group learned theoretical knowledge such as sterile techniques,and observed practical videos about central venous puncture,tracheal intubation,spinal puncture,nerve block,and other skills;and the simulation training group practiced the above skills with intelligent medical simulators in the simulation operating room.After a month of rotation,the trainees were assessed on sterile techniques,invasive procedures,and humanistic care,and questionnaires were used to survey the self-rated and teacher-rated scores of their performance.SPSS 22.0 was used to perform the t test andχ2 test.Results The simulation training group was superior to the control group in terms of the operating processes of tracheal intubation,deep vein puncture,and spinal puncture[(74.16±2.35)vs.(76.05±1.89);(20.22±1.43)vs.(18.61±1.78);(23.17±0.78)vs.(21.11±1.13)],the overall scores of deep vein puncture and spinal puncture[(22.78±1.68)vs.(20.83±1.42);(23.28±0.75)vs.(21.83±1.09)],and the hand-eye coordination and operating time of nerve block[(15.78±1.38)vs.(14.33±1.51);(15.28±1.30)vs.(13.39±1.40)].Conclusions Medical simulation training can significantly improve the post competencies of anesthesia residents to enter clinical rotation,which is worth further promotion.