RESUMO
The aim of this study was to assess the effect of a dynamic electronic cognitive aid with embedded clinical decision support (dCA) versus a static cognitive aid (sCA) tool. Anesthesia residents in clinical anesthesia years 2 and 3 were recruited to participate. Each subject was randomized to one of two groups and performed an identical simulated clinical scenario. The primary outcome was task checklist performance with a secondary outcome of performance using the Anesthesia Non-technical skills (ANTS) scoring system. 34 residents were recruited to participate in the study. 19 residents were randomized to the sCA group and 15 to the dCA group. Overall inter-rater agreement for total checklist, malignant hyperthermia, hyperkalemia and ventricular fibrillation was 98.9%, 97.8%, 99.5% and 99.5% respectively with similar Kappa coefficient. Inter-rater agreement for ANTS partial ratings, however, was only 53.5% with a similar Kappa of 0.15. Mean performance was statistically higher in the dCA group versus the sCA group for total check list performance (15.70 ± 1.93 vs 12.95 ± 2.16, p < 0.0001). The difference in performance between dCA and sCA is most notable in dose-dependent related checklist items (4.60 ± 1.3 vs 1.89 ± 1.23, p < 0.0001), while the performance score for dose-independent checklist items was similar between the two groups (p = 0.8908). ANTS ratings did not differ between groups. In conclusion, we evaluated the use of a sCA versus a dCA with embedded decision support in a simulated environment. The dCA group was found to perform more checklist items correctly.Clinical Trial Registration: Clinicaltrials.gov study #: NCT02440607.
Assuntos
Anestesiologia/educação , Lista de Checagem/instrumentação , Sistemas de Apoio a Decisões Clínicas/instrumentação , Internato e Residência/métodos , Treinamento por Simulação/métodos , Lista de Checagem/normas , Competência Clínica , Tomada de Decisão Clínica , Cognição , Sistemas de Apoio a Decisões Clínicas/normas , Feminino , Processos Grupais , Humanos , Internato e Residência/normas , Masculino , Equipe de Assistência ao Paciente , Treinamento por Simulação/normasRESUMO
Cricothyrotomy is considered an integral procedure in the practice of emergency medicine. The Accreditation Council for Graduate Medical Education requires residents in emergency medicine to demonstrate proficiency in this skill, but because cricothyrotomy is rarely encountered in the clinical setting, alternative methods to teach this high-stakes procedure become an important curricular component in residency training. We present an innovative and inexpensive method for teaching cricothyrotomy using animal trachea and synthetic skin.