背景:近年来,使用有效的方法培训医疗保健专业人员非技术技能的重要性已越来越被认为是预防医疗保健实践中临床错误的一种手段。这项研究的目的是评估教育干预措施对紧急医疗服务和/或重症监护病房环境中非技术技能的有效性。
方法:在PubMed中进行了系统搜索,Scopus,CINAHL,和WebofScience数据库根据预定的纳入和排除标准。在最初的搜索之后,删除重复项后,选择了7952条记录。最后,我们选择了38项研究进行定量分析.假设随机效应模型,对每个结果指标进行了标准化均值变化的单独荟萃分析。应用Cochran的Q统计量和I2指数来验证研究的异质性。使用Duval和Tweedie的修剪和填充方法,进行了方差和元回归的加权分析,以测试潜在的调节剂和漏斗图的影响。和Egger回归检验用于检查发表偏倚。
结果:所有分析的变量都有显著的影响大小,除了态势感知(d+=-0.448;95%置信区间[CI]=-1.034,0.139)。发现知识的平均效应大小最高(d+=-0.925;95%CI=-1.177,-0.673),其次是全球非技术技能的平均效应大小(d+=-0.642;95%CI=-0.849,-0.434),团队非技术技能(d+=-0.606;95%CI=-0.949,-0.262),和领导非技术技能(d+=-0.571;95%CI=-0.877,-0.264)。姿态的平均效应大小相似(d+=-0.406;95%CI=-0.769,-0.044),自我效能感(d+=-0.469;95%CI=-0.874,-0.064),和沟通非技术技能(d+=-0.458;95%CI=-0.818,-0.099)。在meta分析中发现标准化均值变化之间存在较大的异质性(I2>75%,p<.001),除了自我效能感I2=58.17%,Cochran的Q有一个非统计结果。这种巨大的变异性也反映在森林地块上。
结论:使用模拟干预措施对急诊和重症监护医疗保健专业人员进行非技术技能培训可以显着提高知识水平,态度,自我效能感,和非技术技能表现。
In recent years, the importance of training healthcare professionals in nontechnical skills using effective methodologies has been increasingly recognised as a means of preventing clinical errors in the practice of health care. The aim of this study was to evaluate the effectiveness of educational interventions on nontechnical skills in the emergency medical services and/or critical care unit settings.
A systematic search was carried out in the PubMed, SCOPUS, CINAHL, and Web of Science databases according to predetermined inclusion and exclusion criteria. After the initial search, 7952 records were selected after duplicates removed. Finally, a selection of 38 studies was included for quantitative analysis. Separate meta-analyses of standardised mean changes were carried out for each outcome measure assuming a random-effects model. Cochran\'s Q-statistic and I2 index were applied to verify study heterogeneity. Weighted analyses of variance and meta-regressions were conducted to test the influence of potential moderators and funnel plots using Duval and Tweedie\'s trim-and-fill method, and Egger\'s regression test were used to examine publication bias.
All the variables analysed had a significant effect size, with the exception of situational awareness (d+ = -0.448; 95% confidence interval [CI] = -1.034, 0.139). The highest mean effect size was found for knowledge (d+ = -0.925; 95% CI = -1.177, -0.673), followed by the mean effect sizes for global nontechnical skills (d+ = -0.642; 95% CI = -0.849, -0.434), team nontechnical skills (d+ = -0.606; 95% CI = -0.949, -0.262), and leadership nontechnical skills (d+ = -0.571; 95% CI = -0.877, -0.264). Similar mean effect sizes were found for attitude (d+ = -0.406; 95% CI = -0.769, -0.044), self-efficacy (d+ = -0.469; 95% CI = -0.874, -0.064), and communication nontechnical skills (d+ = -0.458; 95% CI = -0.818, -0.099). Large heterogeneity among the standardised mean changes was found in the meta-analyses (I2 > 75% and p < .001), except for self-efficacy where I2 = 58.17%, and there was a nonstatistical result for Cochran\'s Q. This great variability is also reflected in the forest plots.
The use of simulation interventions to train emergency and critical care healthcare professionals in nontechnical skills significantly improves levels of knowledge, attitude, self-efficacy, and nontechnical skills performance.