以模拟教学为主体的整体化儿科体外膜肺技术培训课程效用的评估

来源 :中国小儿急救医学 | 被引量 : 0次 | 上传用户:cjw37600
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目的:评估儿科危重症体外膜肺氧合技术(extracorporeal membrane oxygenation,ECMO)整体化模拟教学课程的效用。方法:由复旦大学附属儿科医院ECMO团队建立教学课程,以团队为单位招募学员,提供模拟教学为主的课程,并对团队成员考核成绩及学员反馈进行统计分析。结果:自2018年5月开展起,共有22家儿科专科医院或综合性医院儿科,共计132名学员参加本课程的培训。其中男56名(42.4%),45名重症监护病房(intensive care unit,ICU)医生(34.1%),60名ICU护士(45.5%),23名胸外科医生(17.4%),4名麻醉科医生(3.0%)。12名学员(9.1%)曾有过ECMO治疗经历。学员对于课程设置的各个部分有着较高评价,评分均超过4分。对于理论、技能、团队合作和实施ECMO信心的自我评价均有明显提高,有80.3%的学员对课后开展ECMO技术充满信心。学员们的基线理论考核成绩为(55.2±7.6)分,经培训后再次理论考核成绩为(67.1±7.3)分(n P<0.001)。以团队为单位的操作考核平均成绩为(70.2±8.2)分,合格率达86.4%。操作考核中技能方面较为突出的问题为:遗漏白蛋白和全血预充(90.9%);非技能方面包括感到紧张(84.8%)、团队合作不够流畅(74.2%)、队长的领导力不够(68.2%)。97.0%和94.7%的学员认为整体培训和模拟教学是课程的亮点。有13家(59.1%)学员单位在课程后成功开展ECMO技术,救治患儿人数达到83例,救治成功率54.2%(45/83)。课程后随访发现,2周左右即有学员单位出现技能水平下降。n 结论:本课程作为ECMO模拟教学的全新尝试,在教学及临床双方面取得一定的效果。同时本研究对于ECMO在儿科领域的发展也起到推动作用。“,”Objective:To evaluate the effectiveness of integrated pediatric training course of extracorporeal membrane oxygenation(ECMO)based on simulation teaching.Methods:The instructors of ECMO team of Children′s Hospital of Fudan University developed the teaching curriculum.Team members as a unit were recruited to study simulation-based courses, whose theoretical knowledge, skills and teamwork were assessed, and feedback from the trainees were gathered.Results:Since May 2018, 22 teams of pediatric specialized hospitals or general hospitals have taken part in our ECMO simulation, with totally 132 participants, including 45 ICU doctors(34.1%), 60 ICU nurses(45.5%), 23 thoracic surgeons(17.4%) and four anesthesiologists(3.0%). Twelve of them(9.1%)had a little ECMO experience.After training, the trainees had a high evaluation on each part of the course, with average score more than four, of which the theoretical score was lowest.Their self-evaluation on the theory, skills, teamwork and confidence in the implementation of ECMO had been significantly improved.Most(80.3%)of the trainees were confident to carry out ECMO in their local hospitals.The trainees′ baseline score of theoretical knowledge was 55.2±7.6, and increased to 67.1±7.3 after training(n P<0.001). The average teamwork score of the 22 teams was 70.2±8.2, and the qualified rate was up to 86.4%.The most prominent skill problems in operation assessment were no albumin and blood priming(90.9%), non-skill problems were extremely anxious during the overall assessment(84.8%)of the participants, poor team work(74.2%), poor leadership(68.2%). For the feedback of the whole course, 97.0% and 94.7% of the trainees thought that integrated training and simulation teaching were the highlights of the course.At present, 13(59.1%)units have successfully developed ECMO technology after the course, and the number of children treated has been up to 83, with a survival rate of discharge of 54.2%.However, it was found that the skill level of some participants decreased about 2 weeks after the course.n Conclusion:As a new attempt of ECMO teaching, this curriculum has achieved certain efficiency in both teaching and clinical practice.At the same time, our study also plays a role in promoting the development of ECMO in pediatrics.
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