原位模拟在医学教育中应用的现状、方法与展望

doi:10.3760/cma.j.cn115259-20250131-00107

摘要/Abstract

摘要： 原位模拟作为一种在真实临床环境中进行的模拟培训方法,近年来广泛应用于医学教育中,它与传统中心模拟培训既有相同点,又有很大差别。本文综述了国内外原位模拟的研究现状,探讨原位模拟在非技术性技能提升、系统/流程测试和发现潜在医疗安全隐患等方面的应用价值,分析了我国在原位模拟发展方面与国外的差距。为帮助模拟教师更好地开展教学和评价,本文系统梳理了原位模拟从需求分析到教学实践的全流程实施路径;重点对比了原位模拟与中心模拟的差异,并提出合理化开展的建议;探讨了原位模拟在课程建设和资源整合、新技术应用、评价体系建设和医学伦理及患者安全等方面的挑战,并提出相应的解决对策。希望原位模拟可以更多地在我国医学教育中被应用,在医学专业人才培养和有效提高医疗质量方面发挥更大的作用。

关键词: 教育,医学, 原位模拟, 非技术技能, 患者安全

Abstract: In situ simulation, a form of simulation training conducted within actual clinical settings, has gained considerable traction in medical education in recent years. While it bears similarities to traditional center-based simulation training, it also presents distinct differences. This article provides a comprehensive review of the current research landscape regarding in-situ simulation, both domestically and internationally, examining its value in enhancing non-technical skills, evaluating systems and processes, and identifying potential medical safety risks. Additionally, it highlights the existing gaps in the development of in-situ simulation between China and abroad. To support simulation educators in optimizing their teaching and assessment practices, this article systematically delineates the entire implementation process of in-situ simulation, from needs analysis to instructional execution. A comparative analysis of in-situ simulation and center-based simulation is presented, along with recommendations for its judicious implementation. Furthermore, the article addresses the challenges encountered by in-situ simulation in various domains, including curriculum development, resource integration, the application of emerging technologies, the establishment of evaluation systems, medical ethics, and patient safety, while proposing viable solutions. It is the authors' aspiration that in-situ simulation will see broader application in medical education across China, thereby enhancing the training of healthcare professionals and significantly improving the quality of healthcare delivery.

Key words: Education, medical, In-situ simulation, Non-technical skills, Patient safety

中图分类号:

R-05

葛炯杉, 史迪, 刘继海. 原位模拟在医学教育中应用的现状、方法与展望[J]. 中华医学教育杂志, 2025, 45(4): 264-271.

Ge Jiongshan, Shi Di, Liu Jihai. Current status, methods, and prospects of in situ simulation in medical education[J]. Chinese Journal of Medical Education, 2025, 45(4): 264-271.

参考文献

[1] Martin A, Cross S, Attoe C. The use of in situ simulation in healthcare education: current perspectives[J]. Adv Med Educ Pract, 2020,11:893-903. DOI: 10.2147/AMEP.S188258.
[2] Saqe-Rockoff A, Ciardiello AV, Schubert FD. Low-fidelity, in-situ pediatric resuscitation simulation improves RN competence and self-efficacy[J]. J Emerg Nurs, 2019,45(5):538-544.e1. DOI: 10.1016/j.jen.2019.02.003.
[3] Lois FJ, Pospiech AL, Van Dyck MJ, et al. Is the "in situ" simulation for teaching anesthesia residents a lower cost, feasible and satisfying alternative to simulation center ? A 24 months prospective observational study in a university hospital[J]. Acta Anaesthesiol Belg, 2014,65(2):61-71.
[4] Manggala SK, Tantri AR, Sugiarto A, et al. In situ simulation training for a better interprofessional team performance in transferring critically ill patients with COVID-19: a prospective randomised control trial[J]. Postgrad Med J, 2022,98(1162):617-621. DOI: 10.1136/postgradmedj-2021-141426.
[5] Große Lordemann A, Sommerfeldt D, Mileder L. Latent safety threats in a pediatric emergency department: using in situ simulation to test a new trauma room concept[J]. Z Evid Fortbild Qual Gesundhwes, 2024,187:15-21. DOI: 10.1016/j.zefq.2024.03.005.
[6] Contreras M, Curran E, Ross M, et al. Rapid development of interprofessional in situ simulation-based training in response to the COVID-19 outbreak in a tertiary-level hospital in Ireland: initial response and lessons for future disaster preparation[J]. BMJ Simul Technol Enhanc Learn, 2021,7(3):159-162. DOI: 10.1136/bmjstel-2020-000679.
[7] Maxwell S, Rajala B, Schechtman SA, et al. Development of the obstetric unanticipated difficult video-laryngoscopy algorithm through a quality improvement randomized open-label in situ simulation study[J]. Int J Obstet Anesth, 2024,60:104245. DOI: 10.1016/j.ijoa.2024.104245.
[8] Schoen JC, Klipfel JM, Torbenson VE, et al. Leveraging in situ simulation for implementation of teleobstetric consultation services in rural and community hospitals[J]. Telemed J E Health, 2024,30(8):e2392-e2398. DOI: 10.1089/tmj.2023.0649.
[9] Calhoun AW, Cook DA, Genova G, et al. Educational and patient care impacts of in situ simulation in healthcare: a systematic review[J]. Simul Healthc, 2024,19(1S):S23-S31. DOI: 10.1097/SIH.0000000000000773.
[10] 路坤, 张杰, 汪华学, 等. 原位模拟教学对医学生状态焦虑及临床胜任力影响的研究[J]. 齐齐哈尔医学院学报,2024,45(16):1592-1596. DOI: 10.3969/j.issn.1002-1256.2024.16.017.
[11] 梅琦敏, 张挺, 柴晶晶, 等. 原位情境模拟在临床医学八年制学生ACLS培训中的应用[J]. 协和医学杂志,2023,14(3):660-664. DOI: 10.12290/xhyxzz.2022-0676.
[12] 郭佩佩, 杜伟, 杨林芳. 原位模拟在本科实习护生识别潜在安全隐患能力培训中的应用[J]. 循证护理,2025,11(2):326-330. DOI: 10.12102/j.issn.2095-8668.2025.02.025.
[13] 陈娇, 黄洁, 丁欣. 原位模拟在儿童重症医学科住院医师教学中的应用[J]. 教育教学论坛,2023(49):133-136.
[14] 范学娟, 王恩允, 秦丽莉. 原位模拟教学在急诊住培教学中的应用研究[J]. 中国卫生产业,2024,21(6):172-174,178. DOI: 10.16659/j.cnki.1672-5654.2024.06.172.
[15] 厉蓓, 高越, 王晓楠, 等. 原位模拟结合标准化病人教学方法在全科住院医师规范化培训中的应用效果[J]. 中华全科医师杂志,2020,19(10):947-949. DOI: 10.3760/cma.j.cn114798-20200117-00060.
[16] 王韵, 丁蕾, 胡莺燕, 等. 原位模拟教学法在精神科住院医师规范化培训教学中的应用探索[J]. 上海医药,2024,45(15):7-10,22. DOI: 10.3969/j.issn.1006-1533.2024.15.003.
[17] 谢莉, 魏昕, 许敏, 等. 原位模拟教学法在住培医师麻醉后监护室危机处理教学中的应用效果[J]. 广西医学,2023,45(14):1785-1788. DOI: 10.11675/j.issn.0253-4304.2023.14.26.
[18] 张凡, 曾育辉, 梁秋玲, 等. 原位模拟实践培训法在急诊科综合急救培训中的应用效果[J]. 中国毕业后医学教育,2023,7(6):451-455. DOI: 10.3969/j.issn.2096-4293.2023.06.005.
[19] 戴雨濛, 张薇薇. 基于SPOC平台联合ISS和SP混合教学模式在老年医学教学中的应用[J]. 中国继续医学教育,2024,16(22):47-50. DOI: 10.3969/j.issn.1674-9308.2024.22.010.
[20] 邹康, 张春瑾, 陈红. 紧急剖宫产术原位模拟教学在手术室规培护士培训中的应用[J]. 中国继续医学教育,2023,15(21):144-149. DOI: 10.3969/j.issn.1674-9308.2023.21.031.
[21] 陈军, 乔松, 徐芬, 等. 两种医护团队临床急救综合能力模拟培训方法的对比研究[J]. 中华医学教育杂志,2023,43(6):463-466. DOI: 10.3760/cma.j.cn115259-20220720-00918.
[22] 唐丽梅, 宁文杰, 田素斋, 等. 基于胜任力的神经内科新护士培训实践及效果评价[J]. 中华现代护理杂志,2017,23(15):2069-2073. DOI: 10.3760/cma.j.issn.1674-2907.2017.15.030.
[23] 周勤学, 沈丽娟, 韩慧. 原位模拟训练对提升低年资护士团队协作能力的研究[J]. 浙江医学教育,2019,18(6):31-33,63. DOI: 10.3969/j.issn.1672-0024.2019.06.011.
[24] 刘成林,许思,陈玲.原位模拟在疑似高度传染性疾病患者复用手术器械处置培训中的应用[J]. 中国消毒学杂志, 2023, 40(4): 262-264.
[25] 朱映军, 刘尚昆, 代恒茂, 等. 原位模拟培训在麻醉科护士管理患者术后疼痛中的应用[J]. 麻醉安全与质控,2024,6(4):215-218. DOI: 10.3969/j.issn.2096-2681.2024.04.008.
[26] 李璇璇,刘增粮,杨宏,等. 原位模拟联合遗忘曲线培训模式在创伤护士培训中的应用[J/OL]. 中华医学教育探索杂志,2025, 24[2025-03-11]. https://www.yiigle.com/Journal/Detail/62. DOI:10.3760/cma.j.cn116021-20231008-01990. [网络预发表].
[27] 潘丽丽, 章毅. 探讨跨专业合作原位模拟培训在神经内科护士应急能力培养中的效果研究[J]. 中国高等医学教育,2024(6):110-112. DOI: 10.3969/j.issn.1002-1701.2024.06.046.
[28] Huang G, Yang H, Yao H, et al. Application of multidisciplinary in situ simulation training in the treatment of acute ischemic stroke: a quality improvement project[J]. World J Emerg Med, 2024,15(1):41-46. DOI: 10.5847/wjem.j.1920-8642.2023.084.
[29] 张瑜, 王丽婷, 虞娇, 等. 原位模拟在急危重症患者院内分级转运培训中的应用[J]. 现代医药卫生,2022,38(24):4277-4280. DOI: 10.3969/j.issn.1009-5519.2022.24.029.
[30] INACSL Standards Committee. INACSL Standards of Best Practice: Simulationsm^SM simulation design[J]. Clinical Simulation In Nursing, 2016, 12 Suppl: S5-S12. DOI: 10.1016/j.ecns.2016.09.005.
[31] Barari N, Rezaeizadeh M, Khorasani A, et al. Designing and validating educational standards for E-teaching in virtual learning environments (VLEs), based on revised Bloom′s taxonomy[J]. Interactive Learning Environments, 2022, 30(9): 1640-1652. DOI: 10.1080/10494820.2020.173907.
[32] Bajaj K, Minors A, Walker K, et al. "No-go considerations" for in situ simulation safety[J]. Simul Healthc, 2018,13(3):221-224. DOI: 10.1097/SIH.0000000000000301.
[33] McDermott DS. The prebriefing concept: a Delphi study of CHSE experts[J]. Clinical Simulation in Nursing, 2016, 12(6): 219-227. DOI: 10.1016/j.ecns.2016.02.001.
[34] Fanning RM, Gaba DM. The role of debriefing in simulation-based learning[J]. Simul Healthc, 2007,2(2):115-125. DOI: 10.1097/SIH.0b013e3180315539.
[35] Toale C, Morris M, Roche A, et al. Development and validation of a simulation-based assessment of operative competence for higher specialist trainees in general surgery[J]. Surg Endosc, 2024,38(9):5086-5095. DOI: 10.1007/s00464-024-11024-1.
[36] Lievens F. Assessor training strategies and their effects on accuracy, interrater reliability, and discriminant validity[J]. J Appl Psychol, 2001,86(2):255-264. DOI: 10.1037/0021-9010.86.2.255.
[37] Ismail FW, Ajani K, Baqir SM, et al. Challenges and opportunities in the uptake of simulation in healthcare education in the developing world: a scoping review[J]. MedEdPublish (2016), 2024,14:38. DOI: 10.12688/mep.20271.1.
[38] Motola I, Devine LA, Chung HS, et al. Simulation in healthcare education: a best evidence practical guide. AMEE Guide No. 82[J]. Medical Teacher, 2013, 35(10): e1511-1530. DOI: 10.3109/0142159x.2013.818632.
[39] Naik N, Hameed B, Shetty DK, et al. Legal and ethical consideration in artificial intelligence in healthcare: who takes responsibility?[J]. Front Surg, 2022,9:862322. DOI: 10.3389/fsurg.2022.862322.
[40] Santomauro CM, Hill A, McCurdie T, et al. Improving the quality of evaluation data in simulation-based healthcare improvement projects: a practitioner′s guide to choosing and using published measurement tools[J]. Simul Healthc, 2020,15(5):341-355. DOI: 10.1097/SIH.0000000000000442.