PDF(Pubmed)
Abstract：
BACKGROUND: Simulation-based training (SBT) is vital to complex medical procedures such as ultrasound guided central venous catheterization (US-IJCVC), where the experience level of the physician impacts the likelihood of incurring complications. The Dynamic Haptic Robotic Trainer (DHRT) was developed to train residents in CVC as an improvement over manikin trainers, however, the DHRT and manikin trainer both only provide training on one specific portion of CVC, needle insertion. As such, CVC SBT would benefit from more comprehensive training. An extended version of the DHRT was created, the DHRT + , to provide hands-on training and automated feedback on additional steps of CVC. The DHRT + includes a full CVC medical kit, a false vein channel, and a personalized, reactive interface. When used together, the DHRT and DHRT + systems provide comprehensive training on needle insertion and catheter placement for CVC. This study evaluates the impact of the DHRT + on resident self-efficacy and CVC skill gains as compared to training on the DHRT alone.
METHODS: Forty-seven medical residents completed training on the DHRT and 59 residents received comprehensive training on the DHRT and the DHRT + . Each resident filled out a central line self-efficacy (CLSE) survey before and after undergoing training on the simulators. After simulation training, each resident did one full CVC on a manikin while being observed by an expert rater and graded on a US-IJCVC checklist.
RESULTS: For two items on the US-IJCVC checklist, \"verbalizing consent\" and \"aspirating blood through the catheter\", the DHRT + group performed significantly better than the DHRT only group. Both training groups showed significant improvements in self-efficacy from before to after training. However, type of training received was a significant predictor for CLSE items \"using the proper equipment in the proper order\", and \"securing the catheter with suture and applying dressing\" with the comprehensive training group that received additional training on the DHRT + showing higher post training self-efficacy.
CONCLUSIONS: The integration of comprehensive training into SBT has the potential to improve US-IJCVC education for both learning gains and self-efficacy.
METHODS: Forty-seven medical residents completed training on the DHRT and 59 residents received comprehensive training on the DHRT and the DHRT + . Each resident filled out a central line self-efficacy (CLSE) survey before and after undergoing training on the simulators. After simulation training, each resident did one full CVC on a manikin while being observed by an expert rater and graded on a US-IJCVC checklist.
RESULTS: For two items on the US-IJCVC checklist, \"verbalizing consent\" and \"aspirating blood through the catheter\", the DHRT + group performed significantly better than the DHRT only group. Both training groups showed significant improvements in self-efficacy from before to after training. However, type of training received was a significant predictor for CLSE items \"using the proper equipment in the proper order\", and \"securing the catheter with suture and applying dressing\" with the comprehensive training group that received additional training on the DHRT + showing higher post training self-efficacy.
CONCLUSIONS: The integration of comprehensive training into SBT has the potential to improve US-IJCVC education for both learning gains and self-efficacy.
摘要：
背景：基于模拟的培训（SBT）对于复杂的医疗程序至关重要，例如超声引导的中心静脉导管插入术（US-IJCVC），医生的经验水平会影响发生并发症的可能性。动态触觉机器人训练器（DHRT）的开发是为了培训CVC中的居民，作为对人体模型训练器的改进，然而,DHRT和人体模型培训师都只提供CVC的一个特定部分的培训，针插入。因此，CVCSBT将受益于更全面的培训。创建了DHRT的扩展版本，DHRT+,提供有关CVC其他步骤的实践培训和自动反馈。DHRT+包括一个完整的CVC医疗套件，假静脉通道,和个性化的，反应接口。当一起使用时，DHRT和DHRT+系统提供关于CVC的针头插入和导管放置的全面培训。与单独进行DHRT的训练相比，本研究评估了DHRT对居民自我效能感和CVC技能增益的影响。
方法：47名住院医师完成了DHRT培训，59名住院医师接受了DHRT和DHRT+综合培训。每位居民在接受模拟器培训之前和之后都填写了中心线自我效能感（CLSE）调查。经过模拟训练,每位居民对人体模型进行了一次完整的CVC,同时由专家评估员进行观察,并在US-IJCVC检查表上进行评分.
结果：对于US-IJCVC清单上的两项，“口头同意”和“通过导管吸血”，DHRT+组明显优于单纯DHRT组。两组训练前后的自我效能感均有显著改善。然而,接受的培训类型是CLSE项目“以适当的顺序使用适当的设备”的重要预测因子，以及接受DHRT+额外培训的综合训练组的“用缝线固定导管并应用敷料”，显示出更高的训练后自我效能。
结论：将综合培训整合到SBT中有可能改善US-IJCVC教育，以提高学习收益和自我效能感。
方法：47名住院医师完成了DHRT培训，59名住院医师接受了DHRT和DHRT+综合培训。每位居民在接受模拟器培训之前和之后都填写了中心线自我效能感（CLSE）调查。经过模拟训练,每位居民对人体模型进行了一次完整的CVC,同时由专家评估员进行观察,并在US-IJCVC检查表上进行评分.
结果：对于US-IJCVC清单上的两项，“口头同意”和“通过导管吸血”，DHRT+组明显优于单纯DHRT组。两组训练前后的自我效能感均有显著改善。然而,接受的培训类型是CLSE项目“以适当的顺序使用适当的设备”的重要预测因子，以及接受DHRT+额外培训的综合训练组的“用缝线固定导管并应用敷料”，显示出更高的训练后自我效能。
结论：将综合培训整合到SBT中有可能改善US-IJCVC教育，以提高学习收益和自我效能感。
