“反复强化可提高医学生对经食道超声心脏解剖的学习和理解能力"
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Generative Retrieval Improves Learning and
Retention of Cardiac Anatomy Using Transesophageal Echocardiography
背景与目的
经食管超声心动图（TEE）是监测心脏或非心脏手术患者的一种有价值的监护仪，因为它可以评估围手术期患者的心血管损害。对于麻醉医师和医学生来说，在临床环境中学习使用和解读TEE是很困难的。学习使用和解读TEE的关键是掌握正常心血管超声解剖。
方 法
15名大四医学生和15名一年级或二年级麻醉研究生（PGY）均无心脏麻醉学习或观看正常心血管解剖TEE视频剪辑;参与者学习心脏解剖学并被随机分配到生成检索组（GR）或标准实践组（SP）。 GR组被要求在10秒内口头描述出现在TEE视频中每个未标记的心脏解剖结构。然后，正确标记的TEE视频剪辑给GR组观看5秒以上。 SP组看到与GR组相同的TEE视频剪辑但没有要求SP组给出心脏解剖结构答案;SP组，每个TEE视频图像被标记了正确的解剖结构并给观看15秒。所有参与者在中间（1周）和最后（1个月）时间段接受了正常TEE心血管解剖的测试。使用具有随机截距和随机斜率的线性混合效应模型评估这两个时间段记忆TEE心血管解剖的提高。
结 果
GR（49％±11）和SP（50％±12）基线评分差异无统计学意义，平均差异（95％CI）-1.1％（-9.5，7.3％）。培训 1周后，GR组（90％±5）表现明显优于SP组（82％±11），平均差异（95％CI）为8.1％（1.9％，14.2％）; P = 0.012。一个月的后期测试中两组得分持续显著增加（GR：83％±12; SP：72％±12），平均差异（95％CI）10.2％（1.3〜19.1％）; P = 0.026。混合效应分析显示随着时间的推移TEE心血管解剖的学习显著改善， GR和SP组每周分别为5.9%和3.5%（P = 0.0003），且GR组比SP组略有增长（P = 0.065）。
结 论
医学生和麻醉医生在使用TEE方面的不足经验表明生成检索提高学习和记忆心血管超声解剖并纳入教育经验。
原始文献摘要
Amanda M. Kleiman, MD,Katherine T. Forkin, MD,Allison J. Bechtel, MD,Stephen R. Collins, MD,Jennie Z. Ma, PhD,† Edward C. Nemergut, MD, and Julie L. Huffmyer, MD.Generative Retrieval Improves Learning andRetention of Cardiac Anatomy Using Transesophageal Echocardiography.Anesth Analg 2017;124:1440–4.
BACKGROUND: Transesophageal echocardiography (TEE) is a valuable monitor for patients undergoing cardiac and noncardiac surgery as it allows for evaluation of cardiovascular compromisein the perioperative period. It is challenging for anesthesiology residents and medical students to learn to use and interpret TEE in the clinical environment. A critical component of learning to use and interpret TEE is a strong grasp of normal cardiovascular ultrasound anatomy.
METHODS: Fifteen fourth-year medical students and 15 post-graduate year (PGY) 1 and 2 anesthesiology residents without prior training in cardiac anesthesia or TEE viewed normal cardiovascular anatomy TEE video clips; participants were randomized to learning cardiac anatomy in generative retrieval (GR) and standard practice (SP) groups. GR participants were required
to verbally identify each unlabeled cardiac anatomical structure within 10 seconds of the TEE video appearing on the screen. Then a correctly labeled TEE video clip was shown to the GR participant for 5 more seconds. SP participants viewed the same TEE video clips as GR but there was no requirement for SP participants to generate an answer; for the SP group, each TEE video image was labeled with the correctly identified anatomical structure for the 15 second period. All participants were tested for intermediate (1 week) and late (1 month) retention of normal TEE cardiovascular anatomy. Improvement of intermediate and late retention of TEE cardiovascular anatomy was evaluated using a linear mixed effects model with random intercepts and random slopes.
RESULTS: There was no statistically significant difference in baseline score between GR (49%± 11) and SP (50% ± 12), with mean difference (95% CI) -1.1% (-9.5, 7.3%). At 1 week following the educational intervention, GR (90% ± 5) performed significantly better than SP (82%± 11), with mean difference (95% CI) 8.1% (1.9, 14.2%); P = .012. This significant increase in scores persisted in the late posttest session at one month (GR: 83% ± 12; SP: 72% ±12), with mean difference (95% CI) 10.2% (1.3 to 19.1%); P = .026. Mixed effects analysis showed significant improvements in TEE cardiovascular anatomy over time, at 5.9% and 3.5%per week for GR and SP groups respectively (P = .0003), and GR improved marginally faster than SP (P = .065).
CONCLUSIONS: Medical students and anesthesiology residents inexperienced in the use of TEE showed both improved learning and retention of basic cardiovascular ultrasound anatomy with the incorporation of GR into the educational experience.
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