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Immersive Training Helps Teach(模拟训练 高效安全)

2017-08-16      查看:138次      评论:0条      来源:SP教指委

Immersive Training Experience Helps Teach Safe Opioid Prescribing

仿真训练有益于安全开具阿片类药物处方能力的教学

Simulation and immersive learning techniques appear to be particularly effective and powerful for teaching safe opioid prescribing, according to a new study.

一项最新研究标明,模拟仿真学习方法能够极其有效且有力地帮助教授安全开具阿片类处方药物的能力。


The research involved pain medicine fellows and anesthesiology residents at Stanford University—all trainees at the graduate level—working in a simulated outpatient pain clinic. There, a standardized patient actor played the role of a patient who meets the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) for an opioid use disorder, and is asking for an opioid refill to prevent withdrawal, having presented to the clinician with only one tablet of hydromorphone left.

这项研究涉及了斯坦福大学的疼痛医学研究员和麻醉医师,他们作为研究生阶段的实习生,在一个模拟的疼痛门诊部工作。由一个标准化病人(SP)扮演一个符合DSM-5(精神障碍病人的诊断和统计手册)阿片类药物滥用标准的病人,SP出示给临床医师仅剩的一片氢吗啡酮,并索要更多阿片类药物。

“In this immersive experience, faculty video records the trainees’ ability to determine the appropriate opioid-related diagnosis and risk stratification, to discuss the risk and benefits of providing an opioid, and the safety of their therapy plan,” said author Jordan L. Newmark, MD, associate division chief for education, and pain medicine associate program director at Stanford University School of Medicine, in California.

The trainees finish by writing a simulated dictated patient care note for the medical chart, and these are reviewed, said Dr. Newmark, who is also clinical assistant professor in the Division of Pain Medicine/Department of Anesthesiology, Perioperative & Pain Medicine, Division of Addiction Medicine, at Stanford. Then the patient actors provide validated feedback on the trainees’ clinical skills.

这项研究的作者Jordan.L.NewMark是斯坦福大学医学院教育处副处长和疼痛医学项目副总监。同时,他也是疼痛医学部,麻醉医学部,围手术期疼痛医学和成瘾医学部的临床助理教授。他说:“在这种仿真模拟训练中,教学视频会记录下实习生确定恰当的阿片类药物诊断和其风险层级的能力,介绍阿片类药物的风险、益处及其治疗计划安全性的能力。”这些实习生最后要编写病历中的模拟医嘱,并接受检查。然后,模拟病人会就实习生们的临床技能给出有效地反馈。

“The path of least resistance would be to provide a refill per the patient’s request, without addressing the opioid use disorder,” Dr. Newmark said. “However, the trainees who verbalized to the patient their concerns about the opioid use disorder, and asked the patient to see an addiction medicine specialist for comanagement, were rated as having the highest clinical skills and satisfactory interactions with the patient,” Dr. Newmark said. “These trainees were also more restrictive with opioid prescribing as a safety factor, given the presence of the patient’s DSM-5 diagnostic criteria for an opioid use disorder.”

“最省力的办法就是不考虑药物滥用的危害,病人要多少就给多少。而那些向患者解释滥用阿片类药物的危害并建议与成瘾医学专家会诊的实习生,则被认为具有最好的临床技能和良好的医患沟通技巧。这些实习生更关注DSM-5对阿片类药物滥用的规定标准,更注重安全因素,因而对开具这类处方药物更严格。”Newmark 博士说。


Dr. Newmark said, “I would have expected the opposite, that honoring the patient’s request for more opioid would have made them perceive the trainee in a better light.”    

These results indicate that clinicians should address all opioid- and patient-related concerns “in an empathic manner without fear that they will be perceived as poorly skilled or without empathy,” Dr. Newmark said.

他还表示:“这和我的预期不同,我以为尊重病人需求的实习生会更被认可。”结果表明,临床医师应该以同理心的方式解决所有与阿片类药物和病人有关的问题,而不必担心会被视为技术不熟练或没有同情心。


“I think this is an innovative program that is attuned to several needs: the need to help develop skills in younger physicians early in their careers with the complex diagnostic, cognitive and communication aspects of opioid risk management,” said Steven Passik, PhD, vice president of scientific affairs, education and policy at Collegium Pharmaceuticals, in Canton, Mass. The method “is experiential, in concert with principles of adult learning and allows physicians to develop skills in a situation without actual consequences for a real person. It shows how even a very apparently simple request for a refill or an increase requires a complex thought process, the development of a differential diagnosis about what is driving the request, and then learning how to use resources and skills to proceed safely.”

“我认为这一创新的项目满足了以下几个需求:帮助年轻医师在他们职业早期锻炼复杂诊断技能、阿片类药物风险管控工作的认知和沟通能力”,Steven Passik博士(Collegium制药科技事务教育和政策部副主席)说,“这种方法是经验性的,符合成人学习的原则,能够让医师在没有真实患者的情况中锻炼技能。它表明,即使是看起来很简单的增加或再次开药的要求,都需要一个复杂的思考过程,需要鉴别诊断需求的真实原因,并且利用资源和技能安全的提供卫生服务。”

Dr. Passik also said, “All health care providers need more training of this nature, and then a health care system that routinely allows them to alter their practice flow and patterns so that these common but high-impact clinical situations can be dealt with in full appreciation of their complexity.” He added, “We also need the system to recognize how much thought and effort goes into the proper management of these situations and adequately reimburse practitioners.”

The study results were presented at the 2017 annual meeting of the American Academy of Pain Medicine (poster 159).

—David C. Holzman

Passik博士还说:“所有的卫生服务人员都需要这样的培训,也需要一个能够让他们常规得改变实践流程和模式的医疗系统。这样,那些常规但高风险的情况才能在充分考虑复杂性的前提下得到妥善处理。医疗系统还应该能够识别到这些情况的恰当处理需要什么样的思考和努力,并适当地补偿医务人员。”

研究结果已公布在2017年美国疼痛医学学会年会上。(159展板)


-David C.Holzman

(Presented by International Exchange Center of CSPC,translated from ASPE,16.Aug,2017

以上内容来源于ASPE有关报道,由中国SP教指委国际交流中心翻译  2017.8.16)




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