背景:基于模拟的医学培训已被证明是有效的,并且在民用医院中得到了广泛的应用;但是,目前尚不清楚模拟在美国军事卫生系统(MHS)中的使用范围和有效性。MHS中医疗模拟的当前运行状态未知,并且仍然需要进行全系统评估,以评估是否以及如何采用基于模拟的医学训练的进步来满足当今战士不断变化的需求。了解整个企业的模拟程序中使用的技能和方法的类型对于领导者来说是重要的数据,因为他们在课程开发和资源投资方面规划未来。本研究的目的是调查MHS模拟程序,以确定所教授的技能的普遍性,所服务的学习者的类型,以及这个全球医疗保健系统中最常见的方法。
方法:将模拟活动的横断面调查分发给MHS中所有93个模拟计划的医疗主管。这项调查是由作者根据美国陆军医疗部门公布的关键战时技能清单制定的,海军,和空军。受访者被要求指出在他们的项目中培训的学习者的类型,调查中包含的82项独特技能中,哪些是在其现场培训的,对于每种技能,使用的模拟模式,即,人体模型,标准化患者,部分任务训练器,增强/虚拟现实工具,或尸体/活组织。
结果:从93个(80%)MHS医学模拟培训计划中的75个获得了完整的调查响应。在调查中包括的所有技能中,最常教授的课程主要属于医疗技能和护理技能。在所有网站上,最常见的学习者类别是医生/军人(95%的站点),其次是护士(87%),医生(83%),非医疗战斗救星(59%),以及其他(28%)包括基地急救人员,执法,消防员,和平民。课程提供的技能培训通常包括与医务人员/军人相关的任务(97%),其次是护理(81%)。高级提供商(77%),和一般医疗官(GMO)技能(47%)。
结论:调查表明,所教授的最常见的技能都与受伤点战斗伤员护理有关,并解决了战场上最常见的死亡原因。医生技能培训的可用性,护理技能,和先进的提供者技能在小,中等,和大型节目。然而,与大型计划相比,中小型计划不太可能为高级提供者和转基因生物提供培训。总的来说,这项研究发现,MHS中基于模拟的医疗培训侧重于医疗和护理技能,大型项目更有可能为高级提供者和转基因生物提供培训。现有培训的可用性的潜在差距被确定为超过50%的技能包括在护理,高级提供商,至少80%的为这些学习者提供服务的网站不涵盖GMO技能类别。
BACKGROUND: Simulation-based medical training has been shown to be effective and is widely used in civilian hospitals; however, it is unclear how widely and how effectively simulation is utilized in the U.S. Military Health System (MHS). The current operational state of medical simulation in the MHS is unknown, and there remains a need for a system-wide assessment of whether and how the advances in simulation-based medical training are employed to meet the evolving needs of the present-day warfighter. Understanding the types of skills and methods used within simulation programs across the enterprise is important data for leaders as they plan for the future in terms of curriculum development and the investment of resources. The aim of the present study is to survey MHS simulation programs in order to determine the prevalence of skills taught, the types of learners served, and the most common methodologies employed in this worldwide health care system.
METHODS: A cross-sectional survey of simulation activities was distributed to the medical directors of all 93 simulation programs in the MHS. The survey was developed by the authors based on lists of critical wartime skills published by the medical departments of the US Army, Navy, and Air Force. Respondents were asked to indicate the types of learners trained at their program, which of the 82 unique skills included in the survey are trained at their site, and for each skill the modalities of simulation used, i.e., mannequin, standardized patients, part task trainers, augmented/virtual reality tools, or cadaver/live tissue.
RESULTS: Complete survey responses were obtained from 75 of the 93 (80%) MHS medical simulation training programs. Across all skills included in the survey, those most commonly taught belonged predominantly to the categories of medic skills and nursing skills. Across all sites, the most common category of learner was the medic/corpsman (95% of sites), followed by nurses (87%), physicians (83%), non-medical combat lifesavers (59%), and others (28%) that included on-base first responders, law enforcement, fire fighters, and civilians. The skills training offered by programs included most commonly the tasks associated with medics/corpsmen (97%) followed by nursing (81%), advanced provider (77%), and General Medical Officer (GMO) skills (47%).
CONCLUSIONS: The survey demonstrated that the most common skills taught were all related to point of injury combat casualty care and addressed the most common causes of death on the battlefield. The availability of training in medic skills, nursing skills, and advanced provider skills were similar in small, medium, and large programs. However, medium and small programs were less likely to deliver training for advanced providers and GMOs compared to larger programs. Overall, this study found that simulation-based medical training in the MHS is focused on medic and nursing skills, and that large programs are more likely to offer training for advanced providers and GMOs. Potential gaps in the availability of existing training are identified as over 50% of skills included in the nursing, advanced provider, and GMO skill categories are not covered by at least 80% of sites serving those learners.