目的 探讨原位模拟(in situ simulation,ISS)在急诊科住院医师规范化培训(简称住培)综合急救技能培训中的应用效果。方法 采用试验对照方法。选取 2023年9月至2024年9月在首都医科大学宣武医院急诊科轮转的住培学员67人为研究对象,将其随机分为试验组34人和对照组33人。试验组采用ISS培训方式利用SimMan 3G模拟人开展教学,对照组在医学模拟中心同样利用SimMan 3G模拟人以场外模拟的培训方式开展教学。培训结束后,采用生理驱动高仿真模拟人进行考核,比较两组学员抢救成功时间、抢救成功率;比较两组学员的任务管理等4项非技术技能评分;发放调查问卷,比较两组学员学习兴趣、胜任力等方面的自我评价。采用独立样本t检验、χ2检验等处理相关数据。结果 试验组学员的抢救成功时间短于对照组学员[(7.92±0.86)分钟比(8.43±0.78)分钟]、抢救成功率高于对照组学员[(91.18%)比(72.73%)];试验组学员任务管理能力和情境意识的非技术技能评分均高于对照组学员[(14.54±3.65)分比(12.36±3.54)分,(9.86±1.63)分比(8.83±1.74)分];问卷调查结果显示,试验组学员在学习兴趣和胜任力方面自评分数均高于对照组学员[(4.44±0.66)分比(4.00±0.79)分,(4.32±0.68)分比(3.85±0.79)分]:以上差异均具有统计学意义(均P＜0.05)。结论 在住培综合急救技能培训中应用ISS,有助于提高住培学员的抢救成功率,增强其任务管理能力和情境意识等非技术技能,促进其胜任力的培养。
Objective To study application of in situ simulation(ISS) in comprehensive first aid skills training for emergency standardized training residents. Methods This study adopted an experimental control method. A total of 67 residency trainees who rotated through the Emergency Department of Xuanwu Hospital, Capital Medical University, from September 2023 to September 2024 were enrolled. They were randomly divided into an experimental group (n=34) and a control group (n=33). The experimental group received training through ISS using a SimMan 3G manikin, whereas the control group was trained in the medical simulation center using the same manikin but through off-site simulation. After training, assessments were conducted using high-fidelity physiologically driven manikins to compare the rescue success time and rescue success rate between the two groups. Non-technical skills of trainees in both groups were assessed, and scores in four areas, including task management, were compared. Questionnaires were distributed to compare self-evaluations of learning interest and competency. Data were analyzed using independent samples t-tests, χ2 tests, etc. Results The rescue success time of the experimental group was shorter than that of the control group [(7.92±0.86) minutes vs. (8.43±0.78) minutes], and the rescue success rate was higher than that of the control group [(91.18%) vs. (72.73%)]. The non-technical skill scores for task management and situational awareness in the experimental group were higher than those in the control group [(14.54±3.65) vs. (12.36±3.54) and (9.86±1.63) vs. (8.83±1.74), respectively]. Questionnaire results showed that self-evaluation scores for learning interest and competency were higher in the experimental group than in the control group [(4.44±0.66) vs. (4.00±0.79) and (4.32±0.68) vs. (3.85±0.79), respectively]. All the above differences were statistically significant (all P<0.05). Conclusions The application of ISS in comprehensive emergency skill training for residency trainees helps improve rescue success rates, enhances non-technical skills such as task management and situational awareness, and promotes the development of their competency.
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