| Objective Effective prehospital emergency care can shorten the prehospital delays,increasing the use of the intravenous recombinant tissue-type plasminogen activator or percutaneous coronary intervention for the patients suffering from ischemic cardiovacular and cerebrovascular emergencies,i.e.acute coronary syndrome(ACS)or ischemic stroke,and decrease the mortality and disability rate.Providing emergency staff with prehospital care training in stroke and ACS is extremely essential,but there is a recognition that Chinese emergency staff lack training opportunities in a number of areas.Therefore,this study aimed to explore the prehospital care content of ACS and stroke in China as well as to develop and evaluate software-based virtual patient(VP)simulator for training the care for stroke and ACS,enhancing prehospital clinical performance of emergency staff.Methods(1)The first step: the case design of prehospital care of ACS and stroke and building the software platform for the software-based virtual patient simulator.The prehospital care content and procedure of the diseases were determined by literature research and medical condition.The case development framework was determined by card type intelligent encouragement method.Then the combination of the case content and the case framework has been built,including the formative assessment and interaction.At last,six cases were developed and they were revised by panel meeting.Comparison of similar VP simulators was used to protocol the platform and modules of the software,adopting the experiential learning cycle as the theoretical background.(2)The second step: the initial evaluation and optimization of the software-based VP simulator.Thirty paramedics were invited to use the simulator and then fill in a self-designed questionnaire to evaluate the simulator‘s training effects and using complexity.After collecting the feedback from the paramedics,the study team and software developers optimized the software.(3)The third step: the development of evaluation tools for the software-based VP simulator.The Kirkpatrick‘s models and literature research were used to determine the tools.The validity was determined by a group of experts and the reliability was determined by pretest study.(4)The fourth step: the implementation and evaluation of the software-based VPsimulator.A prospective,single-blinded,randomized controlled trial(RCT)with pretest and posttest was carried out.A total of 142 primary healthcare workers were recruited by convenience sampling.These participants were randomly allocated into VP simulator group(n=71)or face to face simulation group(n=71)by computerized random number generator.Evaluation tools were used to evaluate the participants before and after the intervention.Results(1)The case design of prehospital care of ACS and stroke and building the software platform for the software-based VP simulator.The prehospital emergency treatment workflows for ACS and stroke were determined.Six cases were developed through the designed standardization case framework,including ST-segment Elevation Myocardial Infarction(STEMI),Non–ST-segment elevation acute coronary syndromes(NSTE-ACS),STEMI of atypical symptom,stroke,stroke accompanied with hypertension and stroke accompanied with hyperglycemia.The software platform has seven functional areas.Relative materials were given to the software company and the software-based VP simulator was developed.(2)The initial evaluation and optimization of the software-based VP simulator.After initial evaluation,the majority of respondents reported an increase in knowledge and awareness.Respondents also commented about the weakness of case content and software design,suggesting adding background music and operation sound to create the emergency atmosphere and adding explanation of crucial measures into the summative assessment.The study team and software developers improved the software through adding background music and operation sound,explanation of crucial measures and the operation instruction video.(3)The development of evaluation tools for the software-based VP simulator.The knowledge questionnaire,self-assessment of knowledge,competence and confidence questionnaire,two clinical reasoning assessment checklists(ACS and stroke)and satisfaction questionnaire were developed.The content validity of knowledge and satisfaction questionnaire was good.The Cronbach‘s ? values of satisfaction questionnaire were 0.807 and 0.863.The test-retest reliability of knowledge questionnaire were 0.923 and 0.897.The inter-rater reliability of the clinical reasoning assessment checklists were 0.95 and 0.98.(4)The implementation and evaluation of the software-based VP simulator.The completedata of 130 participants had been got [VP simulator group(n=66)and face to face simulation group(n=64)].The baseline tests between two groups showed no significant statistical difference(P>0.05).Within the two groups,the posttests showed significant differences by comparing the baseline tests.These tests included knowledge(P=0.000),self-assessment of knowledge,competence and confidence(P=0.000),and two face to face simulation tests(P=0.000).The posttests results of knowledge,self-assessment of knowledge,competence and confidence,satisfaction and the stroke case clinical reasoning ability between two groups showed no significant difference(P>0.05),but the ACS case clinical reasoning ability showed significant difference between two groups(P=0.020).The face to face simulation group got the higher scores than the VP simulator group.Conclusion(1)The software-based virtual patient simulator developed by our study was proved to be an effective educational tool.It can improve the self-assessment of knowledge,competence and confidence,first-aid knowledge and clinical reasoning of primary healthcare workers for the prehospital care of ACS or stroke.(2)Compared to the VP simulator,the face to face simulation got better training effect.Therefore,we hope to use the face to face simulation to train the primary healthcare workers who have the opportunities to take part in the continuing medical education in the universities,using the VP simulator as the review tool.To the primary healthcare workers who don‘t have the opportunities but having recived the skill training,we hope to use the VP simulator as the training tool instead of no training,in order to standarize the workflow of pre-hospital care and improve the clinical reasoning of healthcare workers and further benefit real patients. |
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