Experteninterviews zur Praxis des Simulatoreneinsatzes - 2001

Since the end of the 1980s, so-called patient simulators have increasingly been used in anaesthesiology for training and research. The concrete design of simulator settings for teaching, learning or research-oriented use has many levels of freedom. Also due to this complexity, many (functional) relationships are still unclear when using the simulator. Until this project was carried out (2001-2003), there were no systematic studies in anaesthesiology with a comparison of the simulator with the simulated work area (operating room, intensive care unit, emergency room, etc.) in terms of fundamental research. This project was initiated in order to systematically explore the field of action of simulator setting for occupational and organizational psychological research.
The aim was therefore to check whether an analytical concept developed in preliminary studies to describe anesthesiological courses of action in the operating room (OR) is also suitable for the analysis of courses of action in the simulator and whether the two settings can be compared on the basis of the collected data. The activity structure should be described in particular, taking into account the handling of unexpected events. From the comparative analysis of both settings, the ecological validity of simulator settings was to be analysed by means of various data sources - observation and interviews. In addition to the fundamental research-oriented comparison of the two settings, design recommendations for simulator settings should also be deduced.
For the observations, the observation system developed was used to describe the anesthesiological activity and enabled differentiated observations of courses of action in the operating room and in the simulator in comparable laparoscopic operations. The comparison was based on the analysis of the structural composition of the course of action from seven partial actions (communication, observation, measures, documentation, additional activities, miscellaneous, anaesthetist leaves surgery) differentiated according to the anaesthetic phase (initiation of the anaesthetic, middle phase, recovery from the anaesthetic), the setting or type of case (surgical case, routine simulator case, simulator incident) and finally the expertise of the persons involved (interns; assistant doctors).
For the analysis of the ecological validity, in addition to the assessment of the "behavioral realsim" on the basis of the observation data, the experience of the situation by the study participants through semi-structured interviews was collected and the current practice of the use of the simulator through semi-structured interviews with simulator operators was collected.
Beyond the comparison of the views and actions of the participants in relation to simulator setting, it is important for an ecologically valid design of training and research conditions to maintain the close relationship between the simulated work area and simulation. In this project, this was done by means of socio-technical system analyses in a Swiss hospital. The results could be compared with the results of previous examinations in a German hospital.
The research project presented here therefore deals with the possibilities of describing anesthesiological courses of action, both in the operating room and in simulator setting, as well as the comparison of simulator and simulated work area against the background of work practice in the simulated work area. The analyses are used to develop design proposals for simulator setting.

从20世纪80年代末开始，所谓的患者模拟器（patient simulator）在麻醉学领域的培训与研究中应用日益广泛。针对教学、学习或研究导向的模拟器设置（simulator setting），其具体设计存在多维度的自由度。也正因这种复杂性，模拟器使用过程中的诸多（功能层面的）关系仍不明确。在本项目开展前（2001-2003年），麻醉学领域尚未有从基础研究角度对模拟器与模拟工作区域（如手术室、重症监护室、急诊室等）进行对比的系统性研究。本项目的发起旨在为职业与组织心理学研究，系统性探索模拟器设置的作用领域。

因此，本研究的目标在于验证：前期研究中开发的、用于描述手术室（OR）内麻醉操作流程（anesthesiological courses of action）的分析框架，是否同样适用于模拟器中的操作流程分析；以及基于收集的数据，能否对两种场景进行对比。研究需特别描述活动结构，同时考虑对意外事件的处理方式。通过对两种场景的对比分析，借助观察与访谈等多元数据源，剖析模拟器设置的生态效度（ecological validity）。除从基础研究角度对比两种场景外，还需推导模拟器设置的设计建议。

在观察环节，研究采用自主开发的观察系统描述麻醉活动，能够针对可比的腹腔镜手术，对手术室与模拟器中的操作流程进行差异化观察。对比分析基于操作流程的结构组成，该结构由七项子操作（沟通、观察、措施、记录、附加活动、其他、麻醉医师离开手术）构成，并根据麻醉阶段（麻醉诱导、中期、复苏）、场景或病例类型（手术病例、常规模拟器病例、模拟器突发事件）以及参与者的专业水平（实习生、助理医师）进行区分。

在生态效度分析中，除基于观察数据评估“行为真实性（behavioral realism）”外，还通过半结构化访谈收集研究参与者的情境体验，以及通过与模拟器操作者的半结构化访谈，了解模拟器的当前使用实践。

除对比参与者对模拟器设置的看法与行为外，保持模拟工作区域与模拟场景之间的紧密联系，对于培训与研究条件的生态有效设计至关重要。本项目通过在瑞士某医院开展社会技术系统分析（socio-technical system analysis）实现这一点，其结果可与德国某医院此前的研究结果进行对比。

因此，本研究项目探讨了描述手术室与模拟器中麻醉操作流程的可能性，并结合模拟工作区域的实践背景，对比模拟器与模拟工作区域。这些分析用于制定模拟器设置的设计方案。