调查紧急医疗住院cricothyrotomy能力:是三个神奇的数字吗?
Joseph S Turner1, Lauren K Stewart1, Andrew C Hybarger1
1Department of Emergency Medicine Indiana University School of Medicine Indianapolis Indiana USA.
AEM education and training
|November 24, 2023
概括
对于cricothyrotomy培训,熟练程度可以显著提高到六次模拟尝试. 超过六次重复,额外的练习对居民学习这种紧急程序没有进一步的好处.
科学领域:
- 医学教育 医学教育
- 紧急医疗 紧急医疗
- 手术模拟器手术模拟器
背景情况:
- 甲状腺切除术是一种非常重要的紧急手术,在现实世界中应用不频繁.
- 基于模拟的培训对于居住者熟练度至关重要,因为该程序很少见.
- 研究生医学教育认证委员会 (ACGME) 要求在住院期间进行三次cricothyrotomies,但最佳的培训量仍未定义.
研究的目的:
- 为了确定达到熟练程度所需的模拟皮切开术尝试的最低数量.
- 为了确定是否有反复练习的收益下降的点.
主要方法:
- 在学术紧急医疗住院计划中进行了3年的前性观察性研究.
- 一年级住院生 (n=69) 接受了模拟的甲状腺切除训练.
- 主要结果:成功完成程序的时间;次要结果:随后几年的表现;分析包括描述性统计和ANOVA.
主要成果:
- 通过前六次尝试观察到程序完成时间的显著改善 (平均时间从75秒减少到41秒).
- 经过六次尝试后,没有进一步显著提高速度,这表明潜在的熟练程度高原.
- 虽然最初的速度较慢,但第二年和第三年的居民在实践中超过了第一年的表现,展示了更快的完成时间 (例如,第三年居民在五次尝试时24秒).
结论:
- 甲状腺切割训练的好处在于除了ACGME的最低三次尝试之外的额外重复,最优的收益可见在最多六次模拟程序中.
- 建议定期进行再培训,以保持这种高风险的紧急技能的熟练程度.
- 信任度与程序完成时间没有相关性.
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