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16/07/2015

S'entraîner pour son assurance personnelle : Combien ?

Training Modalities and Self-Confidence Building in ALS Providers

Ilia S et Al. . Mil Med. 2012 Aug;177(8):901-6.

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Un document important qui aborde l'impact de la confiance en soi obtenu par l'entraînement. Plusieurs techniques d'entraînement doivent être associée: Simulation et monde réel. Le recours au modèle animal n'apparaît pas significatif. Des plateaux à partir desquels il faut opter pour une autre méthode sont identifiés: Pour l'intubation 30 sur mannequin et 25 en réel, 40 pour l'exsufflation sur mannequin et 3 en réel et 10 pose de KTIO sur simulateur.

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OBJECTIVE:

Physicians and paramedics in the Israel Defense Forces are trained to perform advanced medical procedures using standardized training modalities, such as manikins. We studied the association of experience using these training modalities with self-reported confidence in procedure performance.

METHODS:

Providers were sent a questionnaire regarding their experience with and self-confidence levels for performing endotracheal intubation, cricothyroidotomy, needle chest decompression, tube thoracostomy, and intraosseous infusion.

RESULTS:

Provider level (physician or paramedic) and gender were associated with reported self-confidence levels. Manikin and supervised and unsupervised patient experience exhibited positive associations with self-confidence, but (animal) model experience did not. For many procedure-training modality pairs, we identified a plateau level above which additional experience was minimally associated with an increase in self-confidence.

training Modalities IDF.jpg

CONCLUSIONS:

Among military advanced life support providers, self-confidence levels in procedure performance are positively associated with experience gained from manikins and supervised and unsupervised patient application. We were not able to demonstrate a clear benefit of an animal model in increasing self-confidence. A plateau was generally identified, indicating decreased benefit from the use of a particular training modality for a particular procedure. Modifying training regimens in light of these findings may help maximize the self-confidence of advanced life support providers more efficiently. 

14/06/2015

Transfert de compétences: Oui si organisé !

Amélioration de l'offre des soins obstétricaux par la délégation des tâches en milieu africain Exemple de l'hôpital du district sanitaire de Bogodogo à Ouagadougou, Burkina Faso

Ouédraogo CM et Al. Médecine et Santé Tropicales 2015 ; 00 : 1-5

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La performance du sauvetage au combat tient à un transfert de compétences et savoir faire choisis et pour lesquels des personnels ont été spécifiquement formés. Ainsi la médicalisation de l'avant doit elle être comprise non pas la présence du médecin à l'avant mais la présence de savoir faire. Ce besoin déborde largement le contexte militaire et est bien connu dans les pays où l'infrastructure médicale n'est pas aussi développée qu'en métropole. Le document présenté exprime toute la puissance de ces transferts quand ils sont organisés et bien maîtrisés. 

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Objectif : délégation de la pratique des interventions obstétricales majeures à des infirmiers spécialisés en chirurgie à l’hôpital de district de Bogodogo, Burkina Faso.

Méthode: Etude descriptive, analytique et non expérimentale comparant les prestations de gynécologues-obstétriciens et des infirmiers spécialisés en chirurgie pour des interventions obstétricales majeures. La collecte des données a été réalisée de février à octobre 2013 dans le service de gynécologie obstétrique de l’hôpital du district de Bogodogo. Ont été incluses dans l’étude les femmes qui ont bénéficié d’une intervention obstétricale majeure (IOM) en urgence, par un gynécologue obstétricien ou par un infirmier spécialisé en chirurgie. La collecte des données a été réalisée de février à octobre 2013 dans le service de gynécologie obstétrique de l’hôpital de district de Bogodogo, à l’aide d’une fiche (questionnaire) individuelle. Les données ont été saisies grâce au logiciel EPIDATA, version 3.1, et analysées par SPSS, version 22. Le test de Khi2 a permis la comparaison des proportions et celui de Student la comparaison des moyennes. Le seuil de significativité retenu était de 5%.

Résultats : Au cours de la période d’étude, nous avons colligé 601 cas d’interventions obstétricales majeures dont 65,4% réalisés par les gynécologues obstétriciens. L’âge moyen des femmes était de 26,7 ans. La césarienne était l’intervention obstétricale majeure la plus pratiquée avec fréquence de 90% suivi de la laparotomie avec une fréquence de 7,7%. Dans les cas de césarienne, la technique de Misgav-Ladach a été utilisée respectivement dans 86,5% et 95,3% par les gynécologues obstétriciens et les infirmiers spécialisés en chirurgie.

Délégation IOM.jpg

Conclusion : La délégation de tâches en chirurgie obstétricale est effective à l’hôpital du district de Bogodogo et sans risque selon les résultats de cette étude. Son extension au niveau national permettrait de combler le déficit en ressources humaines hautement qualifiées pour réaliser les IOM dans les hôpitaux de district des régions rurales 

 

21/05/2015

Simulateurs d'airway: Fiables ?

A radiographic comparison of human airway anatomy and airway manikins – Implications for manikin-based testing of artificial airways

Schalk R et Al. Resuscitation. 2015 May 11. pii: S0300-9572(15)00199-9

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La maîtrise des techniques de contrôle des voies aériennes est un des enjeux de la médecine préhospitalière militaire. Le recours à la simulation est devenu très fréquent. Pour autant ce travail montre que cette méthode d'apprentissage a ses limites. L'une d'entre elle est le fait que les simulateurs de tache ne reproduisent pas correctement l'anatomie des voies aériennes.

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Objective

The aim of this prospective, single-center, observational study was to investigate the accuracy of modeling and reproduction of human anatomical dimensions in manikins by comparing radiographic upper airway measurements of 13 different models with humans.

Methods

13 commonly used airway manikins (male or female anatomy based) and 47 controls (adult humans, 37 male, 10 female) were investigated using a mediosagittal and axial cervical spine CT scan. For anatomical comparison six human upper airway target structures, the following were measured: Oblique diameter of the tongue through the center, horizontal distance between the center point of the tongue and the posterior pharyngeal wall, horizontal distance between the vallecula and the posterior pharyngeal wall, distance of the upper oesophageal orifice length of epiglottis distance at the narrowest part of the trachea. Furthermore, the cross-section of the trachea in axial view and the cross-section of the upper oesophageal orifice in the same section was calculated. All measurements were compared gender specific, if the gender was non-specified with the whole sample.

Results

None of the included 13 different airway manikins matched anatomy in human controls= 47) in all of the six measurements. The Laerdal Airway Management Trainer, however, replicated human airway anatomy at least satisfactorily.

Comparison Manikin.jpg

Conclusion

This investigation showed that all of the examined manikins did not replicate human anatomy. Manikins should therefore be selected cautiously, depending on the type of airway securing procedure. Their widespread use as a replacement for in vivo trials in the field of airway management needs to be reconsidered.

 

 

| Tags : airway

02/05/2015

Haute fidélité: Utile ? Pas si sûr

 The use of high-fidelity manikins for advanced life support training. A systematic review and meta-analysis

Cheng A et All. Resuscitation. 2015 Apr 14. pii: S0300-9572(15)00152-5

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Le recours à la simulation apparaît incontournable en pédagogie médicale. L'emploi de mannequins haute fidélité connait un essort majeur. Si la satisfaction des étudiants semble au rendez-vous, il n'est cependant pas si évident que la simulation haute fidélité soit dimensionnante en terme d'acquisition réelle de savoir faire. Les avis sont partagés. Ainsi C'est travail évoque un niveau de preuve relativement faible voir absent. Compte tenu du coût non négligeable des mannequins haute fidélité, un tel investissement doit donc être réfléchi.

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Objectives:

The objective of this study was to evaluate the effectiveness of high versus low fidelity manikins in the context of advanced life support training for improving knowledge, skill performance at course conclusion, skill performance between course conclusion and one year, skill performance at one year,skill performance in actual resuscitations, and patient outcomes.

Methods:

A systematic search of Pubmed, Embase and Cochrane databases was conducted through January31, 2014. We included two-group non-randomized and randomized studies in any language comparing high versus low fidelity manikins for advanced life support training. Reviewers worked in duplicate to extract data on learners, study design, and outcomes. The GRADE (Grades of Recommendation, Assess-ment, Development and Evaluation) approach was used to evaluate the overall quality of evidence foreach outcome.

Results: 3840 papers were identified from the literature search of which 14 were included (13 randomized controlled trials; 1 non-randomized controlled trial). Meta-analysis of studies reporting skill performanceat course conclusion demonstrated a moderate benefit for high fidelity manikins when compared withlow fidelity manikins [Standardized Mean Difference 0.59; 95% CI 0.13–1.05]. Studies measuring skill performance at one year, skill performance between course conclusion and one year, and knowledge demonstrated no significant benefit for high fidelity manikins

SImulationInterest.jpg

Conclusion:

The use of high fidelity manikins for advanced life support training is associated with moderate benefits for improving skills performance at course conclusion. Future research should definethe optimal means of tailoring fidelity to enhance short and long term educational goals and clinical outcomes.

| Tags : simulateurs

04/04/2015

Simulateur de tâche: Modifié pour + de réalisme!

Rescuing the obese or burned airway: are conventional training manikins adequate? A simulation study

 Howes TE. et Al. Br J Anaesth. 2015 Jan;114(1):136-42

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L'emploi de simulateurs de taches se heurte au problème du réalisme de ces derniers. Cette équipe propose de modifier les simulateurs industriels pour plus de réalité.

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Background. Percutaneous tracheal access is required in more than 40% of major airway emergencies, and rates of failure are high among anaesthetists. Supraglottic airway management is more likely to fail in patients with obesity or neck pathology. Commercially available manikins may aid training. In this study, we modified a standard ‘front of neck’ manikin and evaluated anaesthetists’ performance of percutaneous tracheal access.

Methods. Two cricothyroidotomy training manikins were modified using sections of belly pork to simulate a morbidly obese patient and an obese patient with neck burns.

 

F2.medium.gif

 

An unmodified manikin was used to simulate a slim patient. Twenty consultant anaesthetists were asked to manage a ‘can’t intubate, can’t ventilate’ scenario involving each of the three manikins. Outcome measures were success using their chosen technique and time to first effective breath.

Results. Success rates using first-choice equipment were: ‘slim’ manikin 100%, ‘morbidly obese’ manikin 60%, and ‘burned obese’ manikin 77%. All attempts on the ‘slim’ manikin succeeded within 240 s, the majority within 120 s. In attempts on the ‘morbidly obese’ manikin, 60% succeeded within 240 s and 20% required more than 720 s. All attempts on the ‘burned obese’ manikin succeeded within 180 s.

Conclusions. Significantly greater technical difficulty was experienced with our ‘morbidly obese’ manikin compared with the unmodified manikin. Failure rates and times to completion were considerably more consistent with real-life reports. Modifying a standard manikin to simulate an obese patient is likely to better prepare anaesthetists for this challenging situation. Development of a commercial manikin with such properties would be of value

| Tags : coniotomie

Crico: S'entraîner sur un modèle animal est pertinent ?

 Comparison of manikin versus porcine models in cricothyrotomy procedure training

Cho J et Coll. Emerg Med J 2008;25:732-734

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Le choix du simulateur de tache utilisé  pour l'enseignement de la coniotomie reste une vrai question. Modèle humain, animal ou artificiel. Cet article met en avant l'intérêt du modèle animal qui offrirait plus de réalité anatomique. Néanmoins il faut lire ce document avec un peu de recul car la coniotomie est un geste peu fréquemment réalisé, et probablement que la notion de réalisme porte plutôt sur les aspects anatomiques de la région cervicale que sur le réalisme de pratique de geste sur la région cervicale. Encore faut-il pouvoir dans la vrai vie pouvoir disposer d'une filière d'approvisionnement qui souvent se résume au boucher du quartier. 

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Objective: To compare the usefulness for training of a porcine model (larynx, trachea, and pig skin) and a manikin model using a Portex cricothyrotomy kit (PCK). 

Methods: In a prospective randomised crossover trial, participants in the airway workshop performed crico-thyrotomy using a PCK on the porcine and manikin models (Tracheostomy Trainer and Case). The porcine model was made with larynxes and trachea from freshly slaughtered pigs and covered with a piece of thinned pigskin stapled to a wooden board.

CricoPig.jpg

Participants were asked to assess the following: reality of skin turgor; difficulty with skin penetration, landmark recognition and procedure; reality of the model; and preference for each model using a visual analogue scale (VAS) of 0–10 cm. The VAS scores for each model were compared. 

Results: 49 participants were included in the study. Mean (SD) VAS scores for the reality of skin turgor, degree of difficulty with skin penetration and landmark recognition were higher with the porcine model than with the manikin model (7.0 (2.1) vs 4.7 (2.0), 6.4 (2.4) vs 3.6 (2.2), 5.1 (2.2) vs 4.2 (2.5), respectively). There was no difference between the models in the difficulty of the procedure (5.0 (2.4) vs 4.7 (3.2)). The porcine model had a higher VAS score for overall reality and preference of the model (7.1 (2.0) vs 4.8 (2.3) and 7.1 (2.0) vs 4.8 (2.2), respectively).

CricoPig2.jpg

 Conclusion: The porcine model is a more useful training tool than the manikin model for cricothyrotomy with PCK because of its reality and similarity to human anatomy. 

| Tags : coniotomie

Simulateur de crico: Encore le modèle porcin

A home-made animal model in comparison with a standard manikin for teaching percutaneous dilatational tracheostomy

Interact Cardiovasc Thorac Surg. 2015 Feb;20(2):248-53

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22/03/2015

L'échographie: Investir de son temps pour avoir une pratique fiable

Ultrafest: A Novel Approach to Ultrasound in Medical Education Leads to Improvement in Written and Clinical Examinations

Connolly K et All. West J Emerg Med. 2015 Jan;16(1):143-8.

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L'apprentissage de l'échographie est un impératif en médecine d'urgence. Cependant une véritable qualification ne peut être obtenue qu'au travers de formations universitaires assorties de pratiques réelles et régulières. La pratique des certains protocoles simplifiés comme le FAST serait d'acquisition plus simples. Aussi sont souvent proposées des formations de courtes durées. Ces dernières semblent en théorie très intéressantes en contexte militaire. Une analyse raisonnée de la réalité doit tempérer cet enthousiasme. Le travail présenté montre que si les connaissances théoriques des étudiants sont améliorées par une formation d'une journée, cette dernière ne permet pas l'acquisition d'une pratique suffisamment fiable. Ainsi la formation de nos personnels, qui repose souvent sur des formations de courtes durée, doit elle vue comme une découverte de cette pratique et non pas comme permettant l'acquisition d'un réel savoir  faire.

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Introduction:

Our objective was to evaluate the effectiveness of hands-on training at a bedside ultrasound (US) symposium (“Ultrafest”) to improve both clinical knowledge and image acquisition skills of medical students. Primary outcome measure was improvement in multiple choice questions on pulmonary or Focused Assessment with Sonography in Trauma (FAST) US knowledge. Secondary outcome was improvement in image acquisition for either pulmonary or FAST.

 

Methods:

Prospective cohort study of 48 volunteers at “Ultrafest,” a free symposium where students received five contact training hours. Students were evaluated before and after training for proficiency in either pulmonary US or FAST. Proficiency was assessed by clinical knowledge through written multiple-choice exam, and clinical skills through accuracy of image acquisition. We used paired sample t-tests with students as their own controls.

 

Results:

Pulmonary knowledge scores increased by a mean of 10.1 points (95% CI [8.9-11.3], p<0.00005), from 8.4 to a posttest average of 18.5/21 possible points. The FAST knowledge scores increased by a mean of 7.5 points (95% CI [6.3-8.7] p<0.00005), from 8.1 to a posttest average of 15.6/ 21. We analyzed clinical skills data on 32 students. The mean score was 1.7 pretest and 4.7 posttest of 12 possible points. Mean improvement was 3.0 points (p<0.00005) overall, 3.3 (p=0.0001) for FAST, and 2.6 (p=0.003) for the pulmonary US exam.

 

US Ultrafest.jpg

 

Conclusion:

This study suggests that a symposium on US can improve clinical knowledge, but is limited in achieving image acquisition for pulmonary and FAST US assessments. US training external to official medical school curriculum may augment students’ education

| Tags : échographie

21/03/2015

Simulateur ou vecteur biologique ?

Randomized objective comparison of live tissue training versus simulators for emergency procedures

Hall AB.  Am Surg. 2011 May;77(5):561-5.

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La simulation joue un rôle fondamental dans la foration aux gestes du sauvetage au combat. Le recours au vecteur biologique, au cadavre ou à des simulateurs artificiels reste sujet à débat. Le travail proposé montre que les simulatueurs artificiels sont aussi efficaces que les vecteurs biologiques. L'emploi de cadavres apparaît quand à lui poser le problème de leur disponibilité en nombre suffisant.

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There is a lack of objective analysis comparing live tissue and simulator training. This article aims to objectively determine the difference in outcomes. Twenty-four Air Force volunteers without prior experience performing emergency procedures were randomly assigned to receive training in tube thoracostomy (chest tube) and cricothyroidotomy training on either a pig model (Sus scrofa domestica) or on the TraumaMan simulator. One week posttraining, students were tested on human cadavers with objective and subjective results recorded. Average completion time for tube thoracostomy in the animal model group was 2 minutes 4 seconds and 1 minute 51 seconds in the simulator group with a mean difference of 12 seconds (P = 0.74). Average completion time for cricothyroidotomy in the animal model group was 2 minutes 35 seconds and 3 minutes 29 seconds in the simulator group with a mean difference of 53 seconds (P = 0.32). Overall confidence was 9 per cent higher in the animal trained group (P = 0.42). Success rate of cricothyroidotomy was 75 per cent in the animal model group and 58 per cent in the simulator-trained group (P = 0.67). Success rate of chest tube placement was 92 per cent in the animal group and 83 per cent in the simulator group (P = 1.00). There was no statistically significant difference in chest tube and cricothyroidotomy outcomes or confidence in the groups trained with live animal models or simulators at the 95 per cent confidence interval. Trends suggest a possible difference, but the number of cadavers required to reach greater than 95 per cent statistical confidence prohibited continuation of the study.

| Tags : simulateurs

13/03/2015

Simulation, simple est possible: La coniotomie

Il existe de nombreux simulateurs de coniotomie commerciaux. Ils sont onéreux tant à l'achat que dans leur entretien. Faire simple et peu onéreux est possible.

Premier exemple:

CriCTrainer6.jpg

Clic sur l'image pour accéder à la notice de montage 

Second exemple: 

CriCTrainer_E.jpg

Clic sur l'image pour accéder à la notice de montage

 

Troisième exemple

s12245-014-0046-z-3.jpg

Clic sur l'image pour accéder à la source

| Tags : coniotomie

Simulateur de crico: Un modèle animal facile

An Innovative and Inexpensive Model for Teaching Cricothyrotomy

Wang E. et Al Simul Healthc. 2007 Spring;2(1):25-9 

Une trachée animale: Ici de boeuf

coniotomie

On couvre avec un emballage souple

coniotomie

On s'entraîne

CricoTrainer.jpg

| Tags : coniotomie

12/03/2015

Simulateur de crico: Pas cher, c'est possible

 Every Surgical Resident Should Know How to Perform a Cricothyrotomy: An Inexpensive Cricothyrotomy Task Trainer for Teaching and Assessing Surgical Trainees.

Aho JM et Al. J Surg Educ. 2015 Feb 18. pii: S1931-7204(14)00346-8

OBJECTIVE:

Emergency cricothyrotomy is a rare but potentially lifesaving procedure. Training opportunities for surgical residents to learn this skill are limited, and many graduating residents have never performed one during their training. We aimed to develop and validate a novel and inexpensive cricothyrotomy task trainer that can be constructed from household items.

DESIGN:

A model was constructed using a toilet paper roll (trachea and larynx), Styrofoam (soft tissue), cardboard (thyroid cartilage), zip tie (cricoid), and fabric (skin). Participants were asked to complete a simulated cricothyrotomy procedure using the model. They were then evaluated using a 10-point checklist (5 points total) devised by 6 general surgeons. Participants were also asked to complete an anonymous survey rating the educational value and the degree of enjoyment regarding the model.

CricoTaskTrainer.jpg

SETTING:

A tertiary care teaching hospital.

PARTICIPANTS:

A total of 54 students and general surgery residents (11 medical students, 32 interns, and 11 postgraduate year 3 residents).

RESULTS:

All 54 participants completed the training and assessment. The scores ranged from 0 to 5. The mean (range) scores were 1.8 (1-4) for medical students, 3.5 (1-5) for junior residents, and 4.9 (4-5) for senior-level residents. Medical students were significantly outperformed by junior- and senior-level residents (p < 0.001). Trainees felt that the model was educational (4.5) and enjoyable (4.0).

CONCLUSIONS:

A low-fidelity, low-cost cricothyrotomy simulator distinguished the performance of emergency cricothyrotomy between medical students and junior- and senior-level general surgery residents. This task trainer may be ideally suited to providing basic skills to all physicians in training, especially in settings with limited resources and clinical opportunities.

 

| Tags : coniotomie, matériel

20/12/2014

Simulation: Oui bien sûr, mais ?

The Role of Simulation in Continuing Medical Education for Acute Care Physicians: A Systematic Review

Khanduja PK et Al.  Crit Care Med. 2015 Jan;43(1):186-93.

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Une revue de littérature qui pointe le caractère positif RESSENTI par les participants à un programme de formation continue par simulation. Cette revue de littérature peine à confirmer que ce ressenti se traduit par une réelle amélioration de la prise en charge de nos patients. Les auteurs ne retrouvent en effet qu'une seule étude atteignant les stades 4a et b de Kirkpatrick, c'est à dire des niveaux où sont observés des changements de pratique et un bénéfice objectif pour les patients. Une des difficultés tient au fait que nombre de travaux portent sur l'anesthésie et tout particulièrement en milieu universitaire.  Ils concluent néanmoins à l'intérêt de cette méthode d'enseignement.

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OBJECTIVES:

We systematically reviewed the effectiveness of simulation-based education, targeting independently practicing qualified physicians inacute care specialties. We also describe how simulation is used for performance assessment in this population.

DATA SOURCES:

Data source included: DataMEDLINE, Embase, Cochrane Database of Systematic Reviews, Cochrane CENTRAL Database of Controlled Trials, and National Health Service Economic Evaluation Database. The last date of search was January 31, 2013.

STUDY SELECTION:

All original research describing simulation-based education for independently practicing physicians in anesthesiology, criticalcare, and emergency medicine was reviewed.

DATA EXTRACTION:

Data analysis was performed in duplicate with further review by a third author in cases of disagreement until consensus was reached. Data extraction was focused on effectiveness according to Kirkpatrick's model. For simulation-based performance assessment, tool characteristics and sources of validity evidence were also collated.

DATA SYNTHESIS:

Of 39 studies identified, 30 studies focused on the effectiveness of simulation-based education and nine studies evaluated the validity of simulation-based assessment. Thirteen studies (30%) targeted the lower levels of Kirkpatrick's hierarchy with reliance on self-reporting.

Kirkpatrick.JPGSimulation was unanimously described as a positive learning experience with perceived impact on clinical practice. Of the 17 remaining studies, 10 used a single group or "no intervention comparison group" design. The majority (n = 17; 44%) were able to demonstrate both immediate and sustained improvements in educational outcomes. Nine studies reported the psychometric properties of simulation-based performance assessment as their sole objective. These predominantly recruited independent practitioners as a convenience sample to establish whether the tool could discriminate between experienced and inexperienced operators and concentrated on a single aspect of validity evidence.

CONCLUSIONS:

Simulation is perceived as a positive learning experience with limited evidence to support improved learning. Future research should focus on the optimal modality and frequency of exposure, quality of assessment tools and on the impact of simulation-based education beyond the individuals toward improved patient care.

15/04/2014

Analyse cognitive de tâche: Une nécessité pour l'enseignant

The Effectiveness of a Cognitive Task Analysis Informed Curriculum to Increase Self-Efficacy and Improve Performance for an Open Cricothyrotomy

Campbell J et All. J Surg Educ. 2011 Sep-Oct;68(5):403-7.

 

Un des enjeux de l'apprentissage d'un geste technique est de reproduire la séquence nécessaire tele que décrite par un expert. Hors il est démontré que près de la moitié des phases nécessaires ne sont pas décrites par ces derniers. L'analyse cognitive de tâche est une technique visant à identifier toutes ces phases réalisées de manière inconsciente par les experts qui dès lors de les décrivent pas. La référence proposée porte sur la coniotomie, mais toute activité technique est concernée.

 

OBJECTIVE: This study explored the effects of a cognitive task analysis (CTA)-informed curriculum to increase surgical skills cothyrotomy, procedural skills, surgical skills, curriculum performance and self-efficacy beliefs for medical students and development postgraduate surgical residents learning how to perform an  open cricothyrotomy. 

METHODS: Third-year medical students and postgraduate year 2 and 3 surgery residents were assigned randomly to either the CTA group (n ϭ 12) or the control group (n ϭ 14). The CTA group learned the open cricothyrotomy procedure using the CTA curriculum. The control group received the traditional curriculum.

RESULTS: The CTA group outperformed the control group significantly based on a 19-point checklist score (CTA mean score: 17.75, standard deviation [SD] ϭ 2.34; control mean score: 15.14, SD ϭ 2.48; p ϭ 0.006). The CTA group also reported significantly higher self-efficacy scores based on a 140- point self-appraisal inventory (CTA mean score: 126.10, SD ϭ 16.90; control: 110.67, SD ϭ 16.8; p ϭ 0.029).

CONCLUSIONS: The CTA curriculum was effective in increasing the performance and self-efficacy scores for postgraduate surgical residents and medical students performing an open cricothyrotomy.

07/12/2013

Un modèle de formation hybride ?: A méditer

Evaluation of a training curriculum for prehospital trauma ultrasound.

Press GM et Al. The Journal of Emergency Medicine, Vol. 45, No. 6, pp. 856–864, 2013

 

 

BACKGROUND:

In the United States, ultrasound has rarely been incorporated into prehospital care, and scant descriptions of the processes used to train prehospital providers are available.

OBJECTIVES:

Our objective was to evaluate the effectiveness of an extended focused assessment with sonography for trauma (EFAST) training curriculum that incorporated multiple educational modalities. We also aimed to determine if certain demographic factors predicted successful completion.

METHODS:

All aeromedical prehospital providers (APPs) for a Level I trauma center took a 25-question computer-based test to ascertain baseline knowledge. Questions were categorized by content and format. Training over a 2-month period included a didactic course, a hands-on training session, proctored scanning sessions in the Emergency Department, six Internet-based training modules, pocket flashcards, a review session, and remedial training. At the conclusion of the training curriculum, the same test and an objective structured clinical examination were administered to evaluate knowledge gained.

RESULTS:

Thirty-three of 34 APPs completed training. The overall pre-test and post-test means and all content and format subsets showed significant improvement (p < 0.0001 for all). No APP passed the pre-test, and 28 of 33 passed the post-test with a mean score of 78%. No demographic variable predicted passing the post-test. Twenty-seven of 33 APPs passed the objective structured clinical examination, and the only predictive variable was passing the post-test (odds ratio 1.21, 95% confidence interval 1.00-1.25, p = 0.045).

CONCLUSION:

The implementation of a multifaceted EFAST prehospital training program is feasible. Significant improvement in overall and subset testing scores suggests that the test instrument was internally consistent and sufficiently sensitive to capture knowledge gained as a result of the training. Demographic variables were not predictive of test success.

 
 
 

02/12/2013

Maîtrise des VAS: Simuler il en restera quelque chose

Advanced Airway Management Simulation Training in Medical Education: A Systematic Review and Meta-Analysis

Kennedy CC et All. Crit Care Med 2013; 41:00–00

Airwaysimulation2.jpgSimulatioTraining1.jpg

Les quelques lignes qui suivent sont d'une importance cruciale pour la mise en oeuvre d'une politique de formation à la maîtrise des voies aériennes et le maintien de ces compétences. On ne peut être que surpris par l'intérêt modéré de la pratique au bloc opératoire versus la simulation.

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Educators face many choices when designing a curricula—whether to use lecture, video, web-based teaching, and/or simulation. Our findings have substantial implications for educators and researchers. First, educators designing airway education courses can be confident that simulation is effective in comparison with no intervention for most measured outcomesIt also appears to be more effective than non simulation education (e.g., video, lecture, self-study, and OR training) for many educational outcomes. Second, simulation was associated with higher learner satisfaction compared with nonsimulation interventionsEducators designing simulation curricula face further choices, such as which model(s) to use, how to ensure learners retain the skills, and how to provide feedback. This review begins to answer such questions. Learner satisfaction increased with biologic models. Such preferences may be important in designing curriculum, although evidence is presently lacking with regard to the impact on other learning outcomes. Formal training in the OR in addition to simulation training was not associated with benefit. Although evidence is limited, this finding is of considerable practical import given the substantial commitment by OR personnel and potential safety risks incurred by such training. Addition of standardized patients to airway management training likewise does not appear to be beneficial. Finally, curricula that include course repetition, ongoing practice with or without evaluation with feedback, and use of self-regulated learning appear effective in airway management skill retention and should be incorporated for those requiring skills maintenance.

 


18/10/2013

Simulation: Et le modèle animal ?

Use of Animals by NATO Countries in Military Medical Training Exercises: An International Survey

Gala SG et all. Military Medicine, 177, 8:907, 2012

La formation de nos personnels au sauvetage au combat fait appel de multiples ressources pédagogiques. Le recours à des mannequins plus ou moins sophistiqués est de plus en plus courant. Le modèle animal est toujours d'actualité bien que de plus en plus décrié et encadré. Cet article fait le point sur le recours à un tel modèle par les armées de l'OTAN.

| Tags : pédagogie

09/10/2013

Aide cognitive: Pour gérer une situation de crise

Gérer une situation de crise ne s'improvise pas (CRM: Crisis ressources management). Ceci nécessite la mise en oeuvre de ressources complexes parfaitement décrite dans la figure qui suit et qui doit être bien comprise pour la mise en oeuvre d'un poste de secours.

CRM.jpg

L'université de Stanford fait la promotion de l'emploi de telles aides accessibles sur ce lien.  De telles aides sont également proposées par la SFAR. On peut estimer que la fiche RSA peut être assimilé à une aide cognitive pre et post management CRM.

14/09/2013

Réalité augmentée et sauvetage au combat: Bientôt ?

Using augmented reality as a clinical support tool to assist combat medics in the treatment of tension pneumothoraces.

Wilson KL et All. Mil Med 2013; 178(9):981-5

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La réalité augmentée désigne les systèmes informatiques qui rendent possible la superposition d'un modèle virtuel 3D ou 2D à la perception que nous avons naturellement de la réalité et ceci en temps réel. La commercialisation récente des Google glass est le témoin d'une technologie qui devient mature. Dès lors il n'est pas étonnant qu'un tel dispositif soit utilisé dans les domaines de la formation voire en conditions réelles.  Le travail présenté ci-après n'est qu'un exemple.

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This study was to extrapolate potential roles of augmented reality goggles as a clinical support tool assisting in the reduction of preventable causes of death on the battlefield. Our pilot study was designed to improve medic performance in accurately placing a large bore catheter to release tension pneumothorax (prehospital setting) while using augmented reality goggles. Thirty-four preclinical medical students recruited from Morehouse School of Medicine performed needle decompressions on human cadaver models after hearing a brief training lecture on tension pneumothorax management. Clinical vignettes identifying cadavers as having life-threatening tension pneumothoraces as a consequence of improvised explosive device attacks were used. Study group (n = 13) performed needle decompression using augmented reality goggles whereas the control group (n = 21) relied solely on memory from the lecture. The two groups were compared according to their ability to accurately complete the steps required to decompress a tension pneumothorax. The medical students using augmented reality goggle support were able to treat the tension pneumothorax on the human cadaver models more accurately than the students relying on their memory (p < 0.008). Although the augmented reality group required more time to complete the needle decompression intervention (p = 0.0684), this did not reach statistical significance.

27/06/2013

DU Fosei

A partir de la rentrée universitaire 2013 et dans le cadre du projet SAMSEI , l'université de médecine proposera une formation à la simulation. Fidèle au principe d'enseignement par ilmmersion ce DU est conduit avec l'ensemble des structures universitaires lyonnaises mais aussi le service de santé des armées notamment le CITERA de l'HIA Desgenettes, Le Cefos et l'Institut de recherche du SSA. 

Les modalités pratiques d'inscription à ce DU sont disponibles sur ce lien.

| Tags : simulateurs