BACKGROUND: Simulation training can be beneficial for developing clinical skills without risks to patients. This review considers the literature on simulation models used for teaching closed reduction (manipulation) procedures for distal radius (wrist) fractures, particularly high-fidelity models, and the evidence supporting the use of such models.
METHODS: A scoping review of Medline and Embase was performed.
RESULTS: Five articles described low-fidelity models, predominantly focussing on low costs and teaching basic principles. Three articles and two commentary pieces discussing high-fidelity models were identified.
CONCLUSIONS: Attitudes towards a high-fidelity simulator were assessed by Egan et al. (2013), who found the majority of participants to be in favour of the model\'s use as a teaching tool, although participant selection may have been subject to bias. Mayne et al. (2016) subsequently used a high-fidelity model including radio-opaque markers and more objective measurements tools to assess orthopaedic trainees\' closed reduction technique and adequacy of the achieved fracture position and casting. Seniority correlated with higher scores on objective structured assessment of technical skills (OSATS) and global rating scores (GRS) but not radiological measures of fracture position or cast quality, and over 90% of all participants achieved an adequate reduction. Seeley et al. (2017) used radiological measurements and time to task completion with another high-fidelity reduction model. The two most experienced participant groups could not be differentiated on any radiological measures of fracture reduction or on the time taken for reduction, although these groups were significantly better than the most junior participants.
CONCLUSIONS: The discussed models appear helpful to teach inexperienced participants the basic principles and steps in a procedures but a plateau effect appears to limit the potential benefit to more experienced learners. The constraints of educators\' time and financial costs may influence the usage of such models in this type of training.
背景:模拟训练可以有益于发展临床技能,而不会给患者带来风险。这篇综述考虑了有关用于教导桡骨远端(腕部)骨折的闭合复位(操纵)程序的模拟模型的文献,特别是高保真模型,以及支持使用此类模型的证据。
方法:对Medline和Embase进行范围审查。
结果:五篇文章描述了低保真度模型,主要集中在低成本和教学的基本原则。确定了三篇讨论高保真模型的文章和两篇评论文章。
结论:Egan等人评估了对高保真模拟器的态度。(2013),他们发现大多数参与者都赞成将该模型用作教学工具,尽管参与者的选择可能存在偏见。Mayneetal.(2016)随后使用高保真模型,包括不透射线的标记和更客观的测量工具,以评估骨科学员的闭合复位技术和获得的骨折位置和铸造的充分性。资历与客观结构化技术技能评估(OSATS)和全球评分(GRS)的较高分数相关,但与骨折位置或铸造质量的放射学测量无关。超过90%的参与者实现了足够的减少。Seeley等人。(2017)使用放射学测量和完成任务的时间与另一种高保真减少模型。两个最有经验的参与者组无法在任何骨折复位的放射学措施或复位时间上进行区分。尽管这些组明显优于最初级的参与者.
结论:所讨论的模型似乎有助于向没有经验的参与者传授程序的基本原理和步骤,但平台效应似乎限制了对更有经验的学习者的潜在益处。教育者的时间和财务成本的限制可能会影响此类模型在此类培训中的使用。