基于情景的高仿真模拟在急诊住院医师规范化培训二阶段考核中的应用研究  

The application of scenario-based high simulation in the second-stage assessment of standardized training for emergency residents

作　　者：王苗苗[1] 高珍珍 李小红[2] 郭树彬[1] 梅雪[1] Wang Miao-miao;Gao Zhen-zhen;Li Xiao-hong;Guo Shu-bin;Mei Xue(Emergency Department,Chaoyang Hospital,Capital Medical University,Beijing Key Laboratory of Cardiopulmonary Cerebral Resuscitation,Beijing 100020,China;不详)

机构地区：[1]首都医科大学附属北京朝阳医院急诊科,心肺脑复苏北京市重点实验室,北京100020 [2]首都医科大学附属北京朝阳医院教育处,北京100020

出　　处：《中国急救医学》2021年第12期1051-1055,共5页Chinese Journal of Critical Care Medicine

基　　金：北京市住院医师规范化培训质量提高项目(住培20170023)。

摘　　要：目的基于情景的高仿真模拟方法(下面统称情景模拟)指挥团队进行心肺复苏(CPR)在急诊住院医师规范化培训二阶段考核中的应用效果评价。方法选择参加2019、2020年北京市急诊住院医师规范化培训二阶段考核(急诊住院医师培训满5年)的191名急诊科住院医师为研究对象,二阶段考核内容其中一项为情景模拟下考生指挥团队进行CPR。根据研究对象的调查问卷,将其分为临床工作中未曾独立组织CPR抢救组(n=63)和曾经独立组织CPR抢救组(n=128);同时还分为既往未曾接受过情景模拟培训组(n=57)和曾经接受过情景模拟培训组(n=134)。分别比较两组心脏骤停(cardiac arrest,CA)之前的病情判断、CA的抢救措施、气道管理、胸外按压(按压深度、按压是否回弹、按压频率)、不间断按压、电除颤(能量选择、除颤位置、除颤时机)、自主呼吸循环恢复(return of spontaneous circulation,ROSC)后的处理、人文关怀、团队合作(领导力)和此项考核的总成绩。结果未曾独立组织CPR抢救组CA之前的病情判断、CA的抢救措施、间断按压、除颤时机、ROSC后的处理、人文关怀、团队合作(领导力)及考核总成绩均显著低于曾经独立CPR抢救组,差异有统计学意义(P<0.05);而两组气道管理、胸外按压(深度、频率、回弹)、电除颤(能量选择、除颤位置)比较差异无统计学意义(P>0.05)。未曾接受培训组CA之前的病情判断、CA的抢救措施、不间断按压、除颤时机、ROSC后的处理、人文关怀、团队合作(领导力)及总成绩均显著低于曾经接受培训组,差异有统计学意义(P<0.05);而两组在气道管理、胸外按压(深度、频率、回弹)、电除颤(能量选择、除颤位置)上差异无统计学意义(P>0.05)。结论应用情景模拟方法作为急诊住院医师规范化培训二阶段考核方式,可真实地反映出急诊高年资住院医师的临床急救能力与核心能力。开展基Objective To evaluate the effect of cardiopulmonary resuscitation(CPR)in the second-stage assessment of standardized training for emergency residents after the application of scenario-based high simulation method(hereinafter referred to as scenario simulation).Methods A total of 191 emergency department residents who participated in the second-stage assessment of the standardized training of emergency medical residents in Beijing in 2019 and 2020(emergency medical residents have been trained for five years)were selected as the research objects.One of the second-stage assessment contents was to conduct CPR under the guidance of candidates in scenario simulation.According to the questionnaires,the subjects were divided into two groups:independently organized CPR(n=63)and did not independently organize CPR in clinical work(n=128).At the same time,they were also divided into two groups:had not received scenario simulation training(n=57)and had received scenario simulation training before(n=134).To respectively compare the diagnosis of the disease before cardiac arrest(CA),the rescue measures of CA,airway management,chest compressions(the depth of compressions,whether the compressions bounced back,the frequency of compressions),intermittent compressions,electric defibrillation(energy selection,the location of defibrillation,the timing of defibrillation),the treatment after the return of spontaneous circulation(ROSC),humanistic care,teamwork(leadership),and the total scores of this assessment in both groups.Results The differences of the diagnosis of the disease before CA,the rescue measures of CA,intermittent compression,the timing of defibrillation,the treatment after ROSC,humanistic care,teamwork(leadership)and the total assessment scores were statistically significant between the two groups corresponding to each other(P<0.05).There were no significant differences in airway management,chest compressions(depth,frequency,and rebound),and electric defibrillation(energy selection,defibrillation location)between the two

关 键 词：情景模拟 急诊住院医师规范化培训 急救核心能力 心肺复苏(CPR) 心脏骤停(CA) 自主呼吸循环恢复(ROSC) 

分 类 号：C975[经济管理—劳动经济] R-4[医药卫生]