目的 探讨“提高医疗质量和患者安全的团队策略和工具包”(team strategies and tools to enhance performance and patient safety,TeamSTEPPS)结合真人模拟创伤救治情景在外科住院医师规范化培训中的应用效果。方法 选择2019年1月至12月参加苏州大学附属第一医院急诊科轮转的120名外科住院医师规范化培训医师,以抽签形式平均分为24个团队,再将24个团队以随机数字表法分为试验组和对照组,每组12个团队。两组分别采用TeamSTEPPS结合真人模拟创伤救治情景教学及传统教学方法进行培训,采用团队应急评估措施量表(team emergency assessment measure,Team)评分系统评价教学效果。结果 试验组学员的总分高于对照组[Team总分1分至10分的团队数:试验组0个、1个、1个、0个、3个、1个、2个、2个、1个、1个比对照组3个、2个、0个、3个、1个、1个、1个、1个、0个、0个],差异具有统计学意义(P＜0.05)。结论 TeamSTEPPS结合真人模拟创伤救治情景教学能有效提高外科住院医师创伤救治培训的效果,提高团队的救治能力。
Objective To investigate the effect of TeamSTEPPS combined with all factor real-time simulation of trauma treatment scene teaching in the standardized training of surgical residents compared with the traditional training method. Methods From January to December 2019, 120 trainees were randomly divided into the observation group and the control group with 5 in each team. The training was conducted by TeamSTEPPS combined with all factor real-time simulation of trauma treatment scene teaching and traditional teaching mode, and the effect of the training was evaluated by Team emergency assessment measure. Results The total score of the trainees in the observation group was significantly higher than that in the control group [the number of teams with total team score from 1 to 10: 0, 1, 1, 0, 3, 1, 2, 2, 1, and in the experimental group were 3, 2, 0, 3, 1, 1, 1, 1, 1, 1, 0, 0, 0], the difference was statistically significant(P＜0.05). Conclusions TeamSTEPPS combined with all elements of real-time simulation of trauma treatment scene teaching can effectively improve the effect of standardized training of surgical residents in terms of team work spirit and clinical performance.
[1] 杨鹏,陈恒峰,王龙刚,等. 创伤救治中心建设前后严重多发伤患者救治效果比较[J].中华创伤杂志,2019,35(10):913-917. DOI: 10.3760/cma.j.issn.1001-8050.2019.10.008.
[2]Gondek S, Schroeder ME, Sarani B. Assessment and Resuscitation in Trauma Management[J].Surg Clin North Am,2017,97(5):985-998.DOI: 10.1016/j.suc.2017.06.001.
[3]Wahr JA, Prager RL, Abernathy JH 3rd, et al. Patient safety in the cardiac operating room: human factors and teamwork: a scientific statement from the American Heart Association[J]. Circulation, 2013,128(10):1139-1169. DOI: 10.1161/CIR.0b013e3182a38efa.
[4]Agency for healthcare research and quality.TeamSTEPPS 2.0,2015.[2016-02-08].https://www.ahrq.gov/teamstepps/instructor/fundamentals/index.html
[5]McKay A, Walker ST, Brett SJ, et al. Team performance in resuscitation teams: comparison and critique of two recently developed scoring tools[J]. Resuscitation, 2012,83(12):1478-1483. DOI: 10.1016/j.resuscitation.2012.04.015.
[6]胡培阳,张连阳. 综合性医院创伤救治多学科团队的建设和维护[J].创伤外科杂志,2018,20(9):3. DOI: 10.3969/j.issn.1009-4237.2018.09.023.
[7]Zhang LY, Zhang XZ, Bai XJ, et al. Current trauma care system and trauma care training in China[J]. Chin J Traumatol, 2018,21(2):73-76. DOI: 10.1016/j.cjtee.2017.07.005.
[8]周翔. 如何培养重症医学临床思维能力[J].中华医学杂志,2019,99(25):1934-1937. DOI: 10.3760/cma.j.issn.0376-2491.2019.25.005.
[9]Cooper S, Cant R, Porter J, et al. Rating medical emergency teamwork performance: development of the Team Emergency Assessment Measure (TEAM)[J].Resuscitation,2010,81(4):446-452.DOI: 10.1016/j.resuscitation.2009.11.027.
[10]Berwick DM, Downey AS, Cornett EA. Anational trauma care system to achieve zero preventable deaths after injury: recommendations from a national academies of sciences, engineering, and medicine report[J]. JAMA, 2016,316(9):927-928. DOI: 10.1001/jama.2016.8524.
