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首页> 外文期刊>JAOA: The Journal of the American Osteopathic Association >End of the “See One, Do One, Teach One” Era: The Next Generation of Invasive Bedside Procedural Instruction
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End of the “See One, Do One, Teach One” Era: The Next Generation of Invasive Bedside Procedural Instruction

机译：“见一见成，教一教”时代的终结：下一代有创床边程序教学

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Context: Traditionally, an apprenticeship model has been used for the instruction of invasive bedside procedures. Because this approach is subject to nonuniform application, a new model was established to determine the impact of a standardized curriculum on medical students' and residents' medical knowledge and technical skills.Methods: A procedural instruction curriculum for medical students and residents was developed, and a pilot program with the curriculum was incorporated into an internal medicine residency program. Five common procedures in osteopathic and allopathic internal medicine training programs were included: central venous catheterization, knee arthrocentesis, lumbar puncture, paracentesis, and thoracentesis. An initial assessment of participants' baseline knowledge and skills was obtained. Teaching methods included video instruction; discussion of key concepts; faculty-led, hands-on, simulation-based instruction; and individual deliberate practice. Postinstruction knowledge and skills were evaluated, respectively, through a written test and a quantified assessment (ie, checklist) using direct observation. Participants were asked to provide written feedback at the conclusion of each instructional module.Results: A total of 60 participants, all in allopathic medicine, underwent the training component. Fifty-two participants were internal medicine residents (including 2 from an outside program); 4 were trainees in a combined internal medicine–pediatrics residency; and 4 were medical students (1 from an outside program). Participants demonstrated a statistically significant improvement (P.001) in medical knowledge, as evidenced by preinstruction vs postinstruction test scores. Comparison of initial baseline procedural checklist scores with postinstruction checklist scores, during participants' performance on the first live patient, also showed statistically significant improvement (P.001).Conclusion: A simulation-based, standardized curriculum in invasive bedside procedural instruction significantly improved the medical knowledge and technical skills of novice physicians.
机译：背景：传统上，学徒模式已用于侵入性床边手术的指导。由于该方法应用不统一，因此建立了一个新模型来确定标准化课程对医学生和居民医学知识和技术技能的影响。方法：开发了针对医学生和居民的程序教学课程，并且该课程的试点计划已纳入内科住院医师计划。整骨疗法和同种疗法内部医学培训计划中的五个常见程序包括：中央静脉导管插入术，膝关节穿刺术，腰穿，穿刺和胸腔穿刺术。对参与者的基础知识和技能进行了初步评估。教学方法包括视频教学;讨论关键概念;由教师主导，动手，基于模拟的教学;和个人故意的练习。使用直接观察，分别通过笔试和定量评估（即清单）评估了教学后的知识和技能。要求参与者在每个指导模块的结尾处提供书面反馈。结果：总共有60名参与者都接受了同种疗法药物的培训。 52位参与者为内科住院医师（包括2位来自外部计划的参与者）; 4名是内科和儿科住院医师相结合的实习生; 4名是医学生（1名来自外部计划）。参与者表现出医学知识上的统计学显着性改善（P <.001），这由教学前与教学后测试分数证明。在参与者对第一位活患者的表现期间，将初始基线程序检查清单评分与指令后检查清单评分进行比较，也显示出统计学上的显着改善（P <.001）。结论：基于模拟的标准化课程在有创床旁程序指导中得到了显着改善新手医师的医学知识和技术技能。

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