PDF(Pubmed)
Abstract：
UNASSIGNED: Anesthesiologists and surgeons have demonstrated a lack of familiarity with professional guidelines when providing care for surgical patients with a do-not-resuscitate (DNR) order. This substantially infringes on patient\'s self-autonomy; therefore, leading to substandard care particularly for palliative surgical procedures. The interventional nature of surgical procedures may create a different mentality of surgical \"buy-in,\" that may unintentionally prioritize survivability over maintaining patient self-autonomy. While previous literature has demonstrated gains in communication skills with simulation training, no specific educational curriculum has been proposed to specifically address perioperative code status discussions. We designed a simulated standardized patient actor (SPA) encounter at the beginning of post-graduate year (PGY) 2, corresponding to the initiation of anesthesiology specific training, allowing residents to focus on the perioperative discussion in relation to the SPA\'s DNR order.Forty four anesthesiology residents volunteered to participate in the study. PGY-2 group (n = 17) completed an immediate post-intervention assessment, while PGY-3 group (n = 13) completed the assessment approximately 1 year after the educational initiative to ascertain retention. PGY-4 residents (n = 14) did not undergo any specific educational intervention on the topic, but were given the same assessment. The assessment consisted of an anonymized survey that examined familiarity with professional guidelines and hospital policies in relation to perioperative DNR orders. Subsequently, survey responses were compared between classes.Study participants that had not participated in the educational intervention reported a lack of prior formalized instruction on caring for intraoperative DNR patients. Second and third year residents outperformed senior residents in being aware of the professional guidelines that detail perioperative code status decision-making (47%, 62% vs 21%, P = .004). PGY-3 residents outperformed PGY-4 residents in correctly identifying a commonly held misconception that institutional policies allow for automatic perioperative DNR suspensions (85% vs 43%; P = .02). Residents from the PGY-3 class, who were 1 year removed the educational intervention while gaining 1 additional year of clinical anesthesiology training, consistently outperformed more senior residents who never received the intervention.Our training model for code-status training with anesthesiology residents showed significant gains. The best results were achieved when combining clinical experience with focused educational training.
摘要：
UNASSIGNED：麻醉师和外科医生在为手术患者提供不复苏（DNR）医嘱时，对专业指南不熟悉。这实质上侵犯了患者的自我自主权；因此，导致不合格的护理，特别是姑息性外科手术。外科手术的介入性可能会产生不同的外科手术心态，“这可能无意中优先考虑生存能力而不是维持患者的自我自主性。虽然以前的文献已经证明了模拟训练在沟通技巧方面的进步，尚未提出专门针对围手术期法规状态讨论的具体教育课程.我们在研究生（PGY）2开始时设计了一个模拟的标准化患者演员（SPA）相遇，对应于麻醉学特定培训的开始，允许居民专注于与SPA的DNR命令有关的围手术期讨论。44名麻醉科居民自愿参加了这项研究。PGY-2组（n=17）立即完成了干预后评估，而PGY-3组（n=13）在教育计划后约1年完成评估以确定保留率。PGY-4居民（n=14）没有接受任何特定的教育干预，但得到了同样的评价。评估包括一项匿名调查，检查了与围手术期DNR命令有关的专业指南和医院政策的熟悉程度。随后，在不同类别之间比较了调查响应。未参与教育干预的研究参与者报告缺乏关于术中DNR患者护理的正式指导。第二年和第三年的居民在了解详细的围手术期代码状态决策的专业指南方面优于高级居民（47％，62%vs21%，P=.004）。PGY-3居民在正确识别机构政策允许自动围手术期DNR暂停的普遍误解方面优于PGY-4居民（85％vs43％；P=0.02）。PGY-3班的居民,在获得额外1年的临床麻醉培训的同时，接受了1年的教育干预，始终优于从未接受过干预的高级居民。我们对麻醉科住院医师进行代码状态培训的培训模型显示出明显的收益。将临床经验与重点教育培训相结合，取得了最佳效果。
