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[MEDSCAPE医学新闻]:视频游戏训练能够改进医生技巧
2018年09月13日 时讯速递, 进展交流 暂无评论

Video Game Training Improves Physicians' Skill in RCT

Veronica Hackethal, MD

August 28, 2018

Two types of video games may reduce errors in trauma triage in the emergency department (ED), according to a study published online August 27 in the Proceedings of the National Academy of Sciences.

根据8月27日Proceedings of the National Academy of Sciences在线发表的研究显示,两种视频游戏能够减少急诊科(ED)创伤检诊中的错误。

"In a randomized controlled trial (RCT), both games had positive effects, whereas equivalent exposure to traditional medical education had none. By complementing physicians' natural ways of thinking, such simulated experiences might transfer to actual triage and other high-pressure decisions," write Deepika Mohan, MD, MPH, an assistant professor of surgery and critical care medicine at the University of Pittsburgh in Pennsylvania, and colleagues.

“在一项随机对照试验(RCT)中,两种游戏都有明显效果,而同样接受传统医学教育的医生则不然。通过对医生思考方式的补充,这种模拟经验能够用于真正的检诊及其他高应激状况下的医疗决策,”宾夕法尼亚州匹兹堡大学外科及重症医学助教Deepika Mohan医生及其同事写到。

Prior research shows that 55% to 80% of patients with severe injuries seen at nontrauma centers are not appropriately transferred to trauma centers. Such inadequate triage may contribute to about 30,000 preventable hospital deaths each year, Mohan and colleagues note.

既往研究显示,非创伤中心接诊的严重创伤患者中55%-80%未能正确转院至创伤中心。Mohan医生及其同事指出,这种不正确的检诊可能造成每年约30000例本可预防的住院死亡。

Triage decisions often occur under stressful, time-pressured circumstances in which physicians must draw on "heuristic thinking" or mental shortcuts, such as intuitive judgment, often derived from training and clinical experience. Although often correct, such thinking sometimes results in errors, especially in atypical or rare events.

常常需要在应激状况下在有限的时间内做出检诊决策,此时医生需要依靠“启发性思维”或寻求快捷方式,如直观判断,这常常来自于培训及临床经验。尽管很多情况下是正确的,但是,这种思考有时也会出现错误,尤其是对于不典型或罕见病例。

To see whether video games can improve triage, researchers created two video games intended to improve heuristic thinking. They used medical records, guidelines from the American College of Surgeons, an expert panel, and clinical experiences to develop the games.

为确定视频游戏能否改进检诊,研究者开发了两种视频游戏,旨在改进启发性思维。他们根据病历、美国外科学院指南、专家组及临床经验开发游戏。

One was an adventure game, in which players solved a mystery and role-played as physicians required to decide about trauma triage. The other was a puzzle-based game, in which players triaged sets of trauma patients. Both games included feedback on errors and how to improve them.

其中之一是冒险游戏,游戏者需要解开谜团,其扮演角色如同医生一样需要对创伤检诊做出决策。另一种是拼图游戏,玩家需要对成组的创伤患者进行检诊。两种游戏都包括对发生的错误以及如何改进的反馈意见。

To test the games' efficacy, Mohan and colleagues enrolled 320 emergency medicine physicians in a RCT. Participants were eligible if they worked at a nontrauma or level III/IV trauma center, and thus made triage transfer decisions. On average, they had 8 years of clinical experience, and nearly all (88.8%) were board-certified in emergency medicine.

为验证游戏的效果,Mohan及其同事在一项RCT中纳入了320名急诊科医生。入选者在非创伤或III/IV级创伤中心工作,需要对检诊转诊进行决策。平均而言,入选者具有8年的临床经验,几乎所有人(88.8%)都通过了急诊医学证书考试。

The researchers randomly assigned participants to one of four trial groups: the adventure game, the puzzle game, traditional text-based continuing medical education materials (active control), or no intervention. Those in the intervention and active control group participated in 2 hours of training.

研究者将入选的急诊科医生随机分为4个组:冒险组,拼图组,传统的课本继续教育材料(主动对照),或无干预组。干预组和对照组的医生参加2个小时的培训。

In a 45-minute virtual simulation of 10 cases, physicians assigned to the video games undertriaged significantly fewer patients than those in the no-intervention group: (adventure game difference: −18% [95% confidence interval (CI), −30% to −6%; P = .002]; puzzle game difference: −17% [95% CI, −28% to −6%; P = .003]).

在45分钟的10个病例视频模拟中,与非干预组相比,视频游戏组医生检诊不足的患者病例显著较低(冒险游戏差异:−18% [95% confidence interval (CI), −30% to −6%; P = .002],拼图游戏差异:−17% [95% CI, −28% to −6%; P = .003])。

In contrast, those assigned to the text-based education group undertriaged a similar proportion of patients as the no-intervention group (difference, +8; 95% CI, −3% to +19%; P = .15). "Although well-tolerated by physicians, this active control showed no performance improvement, suggesting that users may have extracted as much as they could from that material already," the authors wrote.

相反,课本教育组的医生检诊不足的患者比例与无干预组相似(差异+8; 95% CI, −3% to +19%; P = .15)。“尽管医生的耐受性很好,但是,这种主动对照措施并不改进行为,提示用户可以已经从资料中收集到尽可能多的信息,”作者写到。

The authors concluded that video games could supplement existing efforts to improve the quality of care in nontrauma centers.

作者得出结论,视频游戏能够辅助现有其他措施,改进非创伤中心的医疗质量。

They note, however, several limitations, including that they recruited participants from a national meeting and may have included a disproportionate number of men and physicians interested in learning. In addition, participants were instructed to use the video games for 2 hours, but use was not objectively verified. Finally, the study could not measure how long the training effect of these video games might last.

然而,作者同时指出研究的一些局限性,包括在全国会议期间纳入研究对象,纳入男性及对学习有兴趣的医生比例较高等。另外,参研医生接受2小时的视频游戏培训,但并未对培训情况进行客观验证。最后,研究没有对视频游戏效果持续的时间进行研究

The study was supported by grants from the National Institutes of Health, the University of Pittsburgh Medical Center for Clinical Decision Making, and the Swedish Foundation for Humanities and Social Sciences. The authors have disclosed no relevant financial relationships.

Proc Natl Acad Sci. Published online August 27, 2018. Full text

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