急诊医学中的灵活内窥镜插管：混合方法需求评估

IF 1.7 Q2 EDUCATION, SCIENTIFIC DISCIPLINES AEM Education and Training Pub Date : 2024-05-16 DOI:10.1002/aet2.10992

Benjamin J. Sandefur MD, MHPE, Eric F. Shappell MD, MHPE, Ronna L. Campbell MD, PhD, Calvin A. Brown III MD, Brian E. Driver MD, Jestin N. Carlson MD, MSc, MHA, Aidan F. Mullan MA, Yoon Soo Park PhD, Ara Tekian PhD, MHPE

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引用次数: 0

摘要

目的本需求评估旨在增进对急诊医学（EM）中柔性内窥镜插管培训和实践的了解，为教育者和实践领导者提供见解，以改进教育和实践。方法我们对急诊医生（EPs）进行了一次多中心、混合方法的需求评估，其中包括焦点小组和调查。焦点小组由社区急诊医生、学术急诊医生和住院急诊医生组成。我们采用基础理论分析了焦点小组的记录，对急诊内窥镜插管进行了定性描述。定性分析形成了我们的调查工具，我们以横截面的方式部署了调查工具。我们通过描述性统计来报告调查数据。结果与 13 名急救医生进行的焦点小组讨论确定了三个主题：使用内窥镜插管的适应症、影响医生决定进行内窥镜插管的因素以及获得和保持内窥镜插管能力。在接受调查的 257 名 EPs 中（回复率为 33%），79% 的人在住院医师培训期间接受过内窥镜插管培训，但 82% 的人在其职业生涯中实施过 10 次或更少。尽管有 97% 的人承认有必要具备相应的能力，但只有 23% 的人对自己实施内窥镜插管的能力非常有信心。参与者（93%）表示很少有机会实施该手术，并指出了有助于获得和保持能力的因素，包括在实践中实施内窥镜插管的机会（98%）、当地冠军（93%）以及实施鼻咽镜检查（87%）。结论虽然大多数急诊科医生都承认具备内窥镜插管能力的重要性，但他们报告称手术机会很少，而且普遍表示信心不足。我们提出了加强内窥镜插管相关教育和实践的途径。这些途径包括开发强大的程序课程、支持当地冠军，以及将鼻咽镜纳入急诊实践。

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Flexible endoscopic intubation in emergency medicine: A mixed-methods needs assessment

Objectives

This needs assessment aimed to improve understanding of flexible endoscopic intubation training and practice in emergency medicine (EM), providing insights to educators and practice leaders seeking to improve education and practices.

Methods

We conducted a multicenter, mixed-methods needs assessment of emergency physicians (EPs) incorporating focus groups and a survey. Focus groups comprised community EPs, academic EPs, and resident EPs. We analyzed focus group transcripts using grounded theory, qualitatively describing EM endoscopic intubation. The qualitative analysis shaped our survey instrument, which we deployed in cross-sectional fashion. We report survey data with descriptive statistics.

Results

Focus groups with 13 EPs identified three themes: indications for use of endoscopic intubation, factors impacting a physician's decision to endoscopically intubate, and attaining and maintaining endoscopic intubation competency. Of 257 surveyed EPs (33% response rate), 79% had received endoscopic intubation training during residency, though 82% had performed this procedure 10 or fewer times in their career. Despite 97% acknowledging the necessity of competency, only 23% felt highly confident in their ability to perform endoscopic intubation. Participants (93%) reported scarce opportunities to perform the procedure and identified factors believed to facilitate competency acquisition and maintenance, including opportunities to perform endoscopic intubation in practice (98%), local champions (93%), and performing nasopharyngoscopy (87%).

Conclusions

While most EPs acknowledged the importance of competency in endoscopic intubation, they reported scarce procedural opportunities and commonly expressed low confidence. Further research is needed on this topic, and we propose avenues to enhance education and practices related to endoscopic intubation. These include development of robust procedural curricula, support of local champions, and incorporating nasopharyngoscopy into EM practice.

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