Resilient system performance in high-stakes settings, which includes the ability to monitor, respond, anticipate, and learn, can be enhanced for trainees through simulation of realistic scenarios enhanced by augmented reality. Active learning strategies can enhance simulation-based training, particularly the mental model articulation principle where students are prompted to anticipate what will happen next and the reflection principle where students self-assess their performance compared to a gold standard expert model. In this paper, we compared simulation-based training for trauma care with and without active learning strategies during pauses in the simulated action for progressively deteriorating patients. The training was conducted online and real-time without a facilitator, with 42 medical students viewing training materials and then immediately taking an online quiz for three types of trauma cases: hemorrhage, airway obstruction, and tension pneumothorax. Participants were randomly assigned to either the experimental or control condition in a between-subjects design. We compared performance in the control and experimental conditions based on: A) the proportion of cues correctly recognized, B) the proportion of accurate diagnoses, C) the proportion of appropriate treatment interventions, and D) verbal briefing quality on a 1–5 scale. We found that the training intervention increased recognition of subtle cues critical for accurate diagnosis and appropriate treatment interventions; the training did not improve the accuracy of diagnoses or the quality of the verbal briefing. We conclude that incorporating active learning strategies in simulation-based training improved foundational capabilities in detecting subtle cues and intervening to rescue deteriorating patients that can increase the readiness for trainees to contribute to resilient system performance in the high-stakes setting of emergency care in hospitals.

中文翻译：

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虚拟患者基于案例的培训策略：整合心理模型清晰度和自我反思影响的实验研究

通过增强现实增强的真实场景模拟，可以增强学员在高风险环境中的弹性系统性能，包括监控、响应、预测和学习的能力。主动学习策略可以增强基于模拟的培训，特别是心理模型清晰度原则（提示学生预测接下来会发生什么）和反思原则（学生与黄金标准专家模型相比自我评估自己的表现）。在本文中，我们比较了针对病情逐渐恶化的患者在模拟动作暂停期间使用和不使用主动学习策略的基于模拟的创伤护理训练。培训在没有主持人的情况下在线实时进行，42名医学生观看了培训材料，然后立即针对出血、气道阻塞和张力性气胸三种类型的创伤病例进行了在线测验。在受试者间设计中，参与者被随机分配到实验条件或控制条件。我们根据以下因素比较了对照条件和实验条件下的表现：A) 正确识别线索的比例，B) 准确诊断的比例，C) 适当治疗干预的比例，以及 D) 口头简报质量（按 1-5 级评分） 。我们发现，培训干预增加了对微妙线索的识别，这对于准确诊断和适当的治疗干预至关重要；培训并没有提高诊断的准确性或口头简报的质量。我们的结论是，将主动学习策略纳入基于模拟的培训中，可以提高检测微妙线索和干预抢救病情恶化的患者的基础能力，从而提高学员的准备能力，以便在医院紧急护理的高风险环境中为弹性系统性能做出贡献。