基于危机管理的屏幕模拟对麻醉住院医师非技术性技能培训效果的探索

叶健鸿; 郭隽英; 贺秋兰; 刘宽智; 杜徐航; 杨璐; 张昆松; 周芹

doi:10.3760/cma.j.cn116021-20260414-02318

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基于危机管理的屏幕模拟对麻醉住院医师非技术性技能培训效果的探索

更新时间：2026-07-01

- 基于危机管理的屏幕模拟对麻醉住院医师非技术性技能培训效果的探索
- Screen-based simulation for crisis management training in anesthesiology residents: evaluation of non-technical skills development
- 中华医学教育探索杂志 2026年页码：1-9
- 作者机构：
  
  1.中山大学附属第一医院麻醉科，广州 510080
  2.中山大学附属第一医院肝胆胰外科中心，广州 510080
- 作者简介：
  
  周芹，Email：zhouqin5@mail.sysu.edu.cn
- 基金信息：
  
  全国医学教育发展中心医学模拟教育研究项目(2021MNZC12)
- DOI：10.3760/cma.j.cn116021-20260414-02318
  中图分类号： R614
- 收稿：2026-04-14，
  
  网络首发：2026-07-01，
- 稿件说明：
移动端阅览
叶健鸿, 郭隽英, 贺秋兰, 等. 基于危机管理的屏幕模拟对麻醉住院医师非技术性技能培训效果的探索[J/OL]. 中华医学教育探索杂志, 2026,1-9.

Ye Jianhong, Guo Junying, He Qiulan, et al. Screen-based simulation for crisis management training in anesthesiology residents: evaluation of non-technical skills development[J/OL]. Chinese Journal of Medical Education Research, 2026, 1-9.
叶健鸿, 郭隽英, 贺秋兰, 等. 基于危机管理的屏幕模拟对麻醉住院医师非技术性技能培训效果的探索[J/OL]. 中华医学教育探索杂志, 2026,1-9. DOI： 10.3760/cma.j.cn116021-20260414-02318.

Ye Jianhong, Guo Junying, He Qiulan, et al. Screen-based simulation for crisis management training in anesthesiology residents: evaluation of non-technical skills development[J/OL]. Chinese Journal of Medical Education Research, 2026, 1-9. DOI： 10.3760/cma.j.cn116021-20260414-02318.

摘要

目的

比较基于结构化反馈的屏幕模拟（screen-based simulation，SBS）与高仿真模拟（high-fidelity simulation，HFS）对麻醉住院医师非技术性技能（anaesthetists’ non-technical skills，ANTS）培训的效果。

方法

将2022年6月至2024年6月在中山大学附属第一医院麻醉专业基地的48名住院医师随机分为SBS组与HFS组（各24名）。两组均接受每周1次、连续3周的危机案例培训及导师结构化反馈。于培训后第4周及3个月后行原位模拟考核；由3名盲法评价员评定ANTS总分、4个维度（态势感知、团队合作、任务管理、决策制定）得分、关键行为完成率及团队协作次数，并进行满意度调查。借助SPSS 26.0分析数据，采用单侧95%置信区间法进行非劣效性检验。

结果

培训后第4周，两组ANTS总分及4个维度得分均较基线显著提升（

0.001），其中SBS组总分为11.81±2.18，HFS组总分为12.02±1.54，组间差异无统计学意义（

=-0.39，

=0.702，Cohen’s

=-0.11），4个维度得分差异亦无统计学意义（均

0.05）。3个月后评估，两组ANTS总分维持稳定，SBS组（11.70±1.90）与HFS组（11.90±1.80）差异仍无统计学意义（

=-0.42，

=0.710，

=-0.11）。两组关键行为完成率的组间差异无统计学意义（

0.05），但HFS组团队协作次数显著高于SBS组（

0.001）；两组均认同培训有效，尽管62.50%的学员更偏好HFS体验，但该偏好未转化为客观技能优势。

结论

基于结构化反馈的屏幕模拟能有效提升并维持麻醉住院医师危机处理的非技术性技能，效果不劣于HFS，且具备低成本、易推广的优势，可作为常态化临床模拟培训的补充。

Abstract

Objective

To evaluate the effect of screen-based simulation (SBS) with structured feedback versus high-fidelity simulation (HFS) in anesthetists' non-technical skills (ANTS) training.

Methods

A total of 48 residents at the anesthesiology training base of The First Affiliated Hospital

Sun Yat-sen University were randomly assigned to the SBS group or HFS group (

=24 each) from June 2022 to June 2024. Both groups received weekly crisis scenario training and str

uctured feedback from instructors for 3 consecutive weeks. At the 4th week and 3 months post-training

trainees were assessed via

in situ

simulations using new cases. Three blinded raters evaluated the total ANTS score and the scores of four dimensions (situation awareness

team working

task management

and decision making)

key behavior completion rate

and team collaboration frequency. Trainee satisfaction was surveyed. SPSS 26.0 was used for data analysis

and non-inferiority was assessed using a one-sided 95% confidence interval.

Results

At the 4th week post-training

the total ANTS score and scores of the four dimensions improved significantly from baseline in both groups (

0.001)

with no significant difference between the SBS group and the HFS group for the total score (11.81±2.18 vs. 12.02±1.54

=-0.39

=0.702

Cohen's

=-0.11) or any of the four dimensions (

0.05). At 3 months post-training

the total ANTS score remained stable with no significant difference between the SBS group and the HFS group (11.70±1.90 vs. 11.90±1.80

=-0.42

=0.710

=-0.11). The key behavior completion rate was not significantly different between the two groups (

0.05)

but the HFS group had significantly more team collaborations than the SBS group (

0.001). All trainees found the training effective; although 62.50% preferred HFS

this did not translate into objective skill advantages. Conclusionss　SBS with structured feedback can effectively enhance and maintain ANTS during crisis management

and is non-inferior to HFS. With its cost-effectiveness and scalability

SBS with structured feedback can serve as a supplementary approach for routine clinical simulation training.

关键词

Keywords

references

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