運用擬真教學提高PGY病房高級心臟救命術執行度之成效探討

An Investigation on the Effectiveness of Simulation Teaching to Improve ACLS Performance in the PGY Simulation Ward

鍾焜明(Kun-Ming Chung) ； 葉正發(Cheng-Fa Yeh) ； 王淑慎(Shu-Shen Wang) ； 郭妍伶(Yen-Ling Ko) ； 柯雅婷(Ya-Ting Ke)

《台灣擬真醫學教育期刊》 5卷2期 (2018/12) Pp. 26-37

https://doi.org/10.6582/JTSSH.201812_5(2).0003

摘要

背景與目的：高級心臟救命術（Advanced Cardiac Life Support, ACLS，以下簡稱ACLS）核心能力攸關病人安全與醫療品質。本研究運用臨床模擬人及擬真教學模式，教導畢業後一般醫學訓練（Post-Graduate Year, PGY，以下簡稱PGY）醫師將高級心臟救命術的專業知識應用於臨床實務，評量學員臨床處置、專業判斷與團隊溝通，以探討擬真情境教學的學習成效。研究方法：本研究採單組前後測實驗設計，24位PGY醫師由兩位臨床教師使用「PGY高級心臟救命術實作評量表」進行OSCE評分，前測時間選定2018年2至7月，導入高擬真高級心臟救命術實作教學與臨床情境實習後，後測時間為2019年3至4月。以Wilcoxon Matched-Pairs Signed-rank Test檢測PGY醫師前後評量的差異，並以Kappa係數進行考官評值一致性檢測（Inter-rater Reliability）。「PGY高級心臟救命術實作評量表」的專家內容效度CVI達0.85。研究結果：24位PGY醫師同時經過第一位臨床教師評核（z = -4.249，p ＜ 0.00）與第二位臨床教師評核（z = -4.359，p ＜ 0.00）介入擬真教學的前、後測OSCE評量，其正確性皆達顯著差異，二名臨床教師評核Kappa值達0.833（p ＜ 0.00）。而評核實作發現分數偏低的前三名的項目分別為，有無取得第一時間心電圖、是否立即給與去顫電擊、病人無脈搏後是否立即給予Epinephrine。結論：本研究導入高擬真高級心臟救命術實作教學與臨床學習後，追蹤評量24位PGY醫師急救操作能力明顯提升。同步於內科示範病房製作心肺腦復甦（CPCR）提醒卡置放於急救車上，提醒PGY醫師及急救醫療團隊之間可以彼此提醒CPCR常犯的三項缺失，導入高擬真高級心臟救命術實作教學與臨床情境實習後，對突發緊急狀況可做妥善應變與團隊合作，期望提高PGY病房高級心臟救命術的成功率。

關鍵字

高級心臟救命術 ； 擬真教學 ； 畢業後一般醫學訓練醫師

並列摘要

Objective: The ability to perform Advanced Cardiac Life Support (ACLS) is vital to patient safety and healthcare quality. This study investigates the effectiveness of using the SimMan patient simulator and simulation teaching in the empowerment of post-graduate year (PGY) residents' competence in applying ACLS to clinical practice in the simulation ward. Outcome was assessed by evaluation of clinical competence, professional judgement and team communication. Methods: The study used a single group, pre-and post-test design, involving 24 PGY residents. Objective structured clinical examination (OSCE) scores were examined by two clinical evaluators using the PGY ACLS Performance Assessment Scale. The pretest was conducted from February to July 2018; the posttest was measured from March to April 2019 after implementation of high-fidelity ACLS simulation and teaching methods. A Wilcoxon matched-pairs signed-rank test was performed to investigate the difference between the pre-and posttest results and the kappa statistic was used to test the interrater reliability of evaluation data. Content validity index (CVI) of the of the PGY ACLS Performance Assessment Scale was 0.85. Results: Pre-and post-test OSCE scores before and after simulation training for the 24 PGY residents were examined by two clinical evaluators with z = - 4.249 (p ＜ 0.00) and z = - 4.359 (p ＜ 0.00), respectively. The differences in accuracy were significant between pre- and posttest scores of the two evaluators; the kappa score was 0.833 (p ＜ 0.00). The 3 lowest-scoring performances were: 1) ECG was obtained promptly, 2) Timely defibrillation was performed, and 3) Epinephrine was administered immediately when the patient was pulseless. Conclusion: After use of the SimMan patient simulator and simulation teaching technique, ACLS performance of the 24 PGY residents improved significantly. In order to further enhance ACLS competence of the PGY residents and decrease the three most commonly missed steps, ACLS flow sheets were posted in both ambulance and the simulated internal medicine wards as reminders. Simulation ACLS training and teaching model is able to empower the ACLS performance and outcomes in the simulation ward by strengthening emergency response capabilities and teamwork cooperation skills of the PGY residents.

並列關鍵字

Advanced Cardiac Life Support (ACLS) ； Simulation Teaching ； Post - Graduate Year (PGY)