摘要
目的：拟合高仿真模拟教学中纤维支气管镜插管的学习曲线，验证高仿真模拟教学的教学效果。方法选择在北京大学人民医院接受住院医师第一阶段培训，且无纤支镜插管经验的45名麻醉学住院医师作为本研究对象，将其随机分为两组：实验组25人，对照组20人。实验组和对照组医师均观看教学短片，观摩纤支镜插管操作。实验组医师采用 Simbionix GI-Bronch Mentor虚拟真实模拟平台完成25次纤支镜置入气道的模拟操作，对照组医师不进行模拟操作。两组医师均在模拟人头上进行5次考核。记录实验组医师每次模拟培训的操作时间，拟合学习曲线。对比两组医师操作时间和纤支镜操作能力评分。对比实验组医师培训前后的信心评分。结果学习曲线拟合的专业级操作时间为9．3（8．7，10．0）秒，19（15，26）次操作后学习曲线进入平台期。实验组医师的操作时间及操作能力评分均优于对照组医师，F ＝24．993、P ＜0．001，F＝107．357、P ＜0．001，差异具有统计学意义。培训后，实验组医师信心评分高于培训前，t ＝10．708，P ＜0．001，差异具有统计学意义。结论高仿真模拟教学可以使无纤支镜使用经验的初学者快速通过学习曲线的陡峭段，达到专业级操作时间。19次训练和操作时间趋近9．0秒，可以结合使用，作为达到学习目标的终点设置。
Objective To evaluate the learning curves of residents performing flexible fiberoptic intubation in high-fidelity simulation environment,and assess the effects of training.Methods A total of 45 anesthesia residents in their first stage of training in anesthesiology with no experience in flexible fiber-optic intubation at Peking University People’s Hospital were enrolled in the study,and were divided into two groups randomly：the simulator group （25 residents）,and the control group （20 residents）.A stand-ard didactic teaching session which consisted of a short film and a performance by instructor,was given to all participants in both groups.The simulator group then trained for 25 times on virtual reality simulator （Simbionix GI-Bronch Mentor）,while the control group skipped this process.After training,participants in both groups had their performance assessed with the fiberoptic bronchoscope evaluated through the oral route using a simulation manikin.Participants were instructed to attempt to advance the fiberoptic broncho-scope 5 consecutive times to view the carina in the shortest amount of time.The time required to view the carina of each practice on simulator in the simulator group was recorded as pooled data to construct a group learning curve.The procedure time and global rating scale （GRS）of fiberoptic bronchoscope manipulation ability were compared between groups,so did the participant’s confidencebefore and after the training in the simulator group.Results The best fit value of the learning curve for the expert time was 9.3 （8.7,＆amp;nbsp;10.0）s,the saturation of learning from the simulator can be achieved after 19 （15,26）practice ses-sions.The procedure time and GRS in the simulator group were better than the control group （F =24.993,P〈0.001;F =107.357,P〈0.001）.The participant’s confidences in simulator group were increased after training （1.9 ±0.7 vs 4.0 ±0.6,t =10.708,P〈0.001）.Conclusions The simulation-based training with high-fidelity virtual reality s
出处
《中华医学教育杂志》
2016年第1期93-97,共5页
Chinese Journal of Medical Education
基金
2014年北京大学人民医院教育教学研究课题“电子模拟纤维支气管镜教学系统开发”（RD-Edu201419）,“高仿真模拟训练在纤支镜引导气管插管教学中的应用”（RD-Edu-201606）
2014年度北京大学医学部教育教学研究课题“基于模拟教学软件及教学模具的虚拟实验教学在麻醉学气道及血流动力学监测管理中的教学研究”（北医（2014）部教字177号）
关键词
模拟训练
纤支镜插管
虚拟真实模拟装置
学习曲线
Simulation-based training
Flexible fibreoptic intubation
Virtual reality simulators
Learning curves
