Realistic simulation is associated with healthcare professionals’ increased self-perception of confidence in providing acute stroke care: a before-after controlled study

ABSTRACT Background: Simulations are becoming widely used in medical education, but there is little evidence of their effectiveness on neurocritical care. Because acute stroke is a neurological emergency demanding prompt attention, it is a promising candidate for simulation training. Objective: To assess the impact of a stroke realistic simulation course on clinicians’ self-perception of confidence in the management of acute stroke. Methods: We conducted a controlled, before-after study. For our intervention, 17 healthcare professionals participated in a stroke realistic simulation course. As controls, participants were chosen from a convenience sample of attendees to the courses Emergency Neurologic Life Support (ENLS) (18 participants) and Neurosonology (20 participants). All participants responded pre- and post-test questionnaires evaluating their self-perception of confidence in acute stroke care, ranging from 10 to 50 points. We evaluated the variation between pre- and post-test results to assess the change on trainees’ self-perception of confidence in the management of acute stroke. Multivariate analysis was performed to control for potential confounders. Results: Forty-six (83.63%) subjects completed both questionnaires. The post-test scores were higher than those from the pretests in the stroke realistic simulation course group [pretest median (interquartile range - IQR): 41.5 (36.7-46.5) and post-test median (IQR): 47 (44.7-48); p=0.033], but not in the neurosonology [pretest median (IQR): 46 (44-47) and post-test median (IQR): 46 (44-47); p=0.739] or the ENLS [pretest median (IQR): 46.5 (39-48.2), post-test median (IQR): 47 (40.2-49); p=0.317] groups. Results were maintained after adjustment for covariates. Conclusions: This stroke realistic simulation course was associated with an improvement on trainees’ self-perception of confidence in providing acute stroke care.

摘要
背景：模拟教学在医学教育中的应用日益广泛，但目前关于其在神经重症监护领域的有效性证据仍较为匮乏。由于急性脑卒中属于需紧急处置的神经系统急症，其是模拟培训的理想应用场景。
研究目的：本研究旨在评估卒中实景模拟课程对临床医师急性脑卒中管理自信心自我感知的影响。
方法：本研究采用对照前后研究设计。干预组共17名医疗从业人员参与卒中实景模拟课程；对照组则选取参加急诊神经生命支持（Emergency Neurologic Life Support, ENLS）课程（18名参与者）及神经超声学（Neurosonology）课程（20名参与者）的便利抽样参会者。所有受试者均完成前后两份问卷，评估其对急性脑卒中诊疗自信心的自我感知，评分范围为10~50分。本研究通过比较前后测试结果的变化，评估受训者急性脑卒中管理自信心的自我感知变化，并通过多变量分析控制潜在混杂因素。
结果：共有46名（83.63%）受试者完成两份问卷。卒中实景模拟课程组的后测得分显著高于前测[前测中位数（四分位距，interquartile range, IQR）：41.5（36.7~46.5），后测中位数（IQR）：47（44.7~48）；p=0.033]；而神经超声学组[前测中位数（IQR）：46（44~47），后测中位数（IQR）：46（44~47）；p=0.739]及ENLS组[前测中位数（IQR）：46.5（39~48.2），后测中位数（IQR）：47（40.2~49）；p=0.317]的前后测得分无显著差异。经协变量校正后，上述结果仍保持稳定。
结论：本研究结果表明，卒中实景模拟课程可显著提升受训者对急性脑卒中诊疗的自信心自我感知水平。