教學實踐研究 -第1卷 第2期 (2021-09-30)
一般論文

創建多元醫學併大體模擬實境手術— 建立開放式胸腹主動脈修復置換模擬手術情境及學習成效初探

甘宗旦 (Kan Chung-Dann) 國立成功大學醫學系教授 ; 陳維聆 (Chen Wei-Ling) 臺北醫學大學生物醫學工程學系兼任助理教授 ; 林佳勳 (Lin Chia-Hsun ) 輔仁大學醫學系副教授 副教授 ; 許喬博 (Hsu Chiao-Po ) 國立陽明交通大學醫學系副教授 副教授 ; 張睿智 (Chang Jui-Chih) 慈濟學校財團法人慈濟大學醫學系助理教授 助理教授 ; 魏崢 (Wei Jeng ) 振興醫院院長 ; 謝世榮 (Hsieh Shih-Rong ) 臺中慈濟醫院心臟血管中心主任 ; 許俊傑 (Shue Jiunn-Jye ) 高雄長庚醫院胸腔及心臟血管外科主任
第1卷第2期,P29-51
10.7007/JSoTL.202106_1(2).0002
在血管支架蓬勃應用的時代,以血管腔內覆膜支架治療胸腹主動脈瘤已是標準術式,導致年輕外科醫師愈來愈不熟悉傳統開放性胸腹主動脈瘤手術,甚至感到畏懼。但在複雜的胸腹主動脈瘤修復上,仍需以開放式手術進行,因此臺灣血管外科學會舉辦模擬手術,其目的在讓血管外科醫師重新熟悉解剖學與手術過程,並重燃學習外科的熱情。本次課程創新性是以多元教學模式進行,並以醫學人文為基礎,導入科技運用,共有十二名講師和二十八名學員共四十名參與課程。在有效問卷中,參與學員有 75.0%來自醫學中心、 62.5%為主治醫師, 66.6%工作年資小於五年。本文以三個教學評量指標來評估模擬手術教學成效,在胸腹主動脈手術過程知識熟悉度、技術經驗及信心程度,學習介入前後學員評值顯著提升 (p < 0.001),成效良好。而尚須改善項目為學員基本資料表中缺乏性別及年齡變項,以學習者意見主觀衡量模擬訓練介入教育成效之研究較不具客觀性。在未來的展望中,將於課程前建立學員基礎線作為學習的調整及設計;增加操作技能直接觀察評估表,以更客觀的數據進行學習評核。我們需要重新思考血管腔內治療方式的適應症與介入時機,以真誠開放的心胸思考該手術是否對病人最有利,持續精進手術規劃,才可獲得民眾對醫療品質的肯定。
主動脈瘤,血管內支架修復,開放式手術,創新醫學擬真教學,醫學人文
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JSOTL

Medical Simulation with Cadaver Surgery: A Preliminary Study of the Effectiveness of Innovative Medical Simulation with Cadaver Surgery on the Learning of Open Thoracoabdominal Surgery

Kan Chung-Dann ; Chen Wei-Ling ; Lin Chia-Hsun ; Hsu Chiao-Po ; Chang Jui-Chih ; Wei Jeng ; Hsieh Shih-Rong ; Shue Jiunn-Jye
Volume 1/ Issue 2, P29-51
10.7007/JSoTL.202106_1(2).0002
The number of open surgeries for cardiovascular diseases has dramatically decreased due to endovascular therapy’s worldwide use—fewer opportunities for current junior vascular surgeons to learn and familiarize themselves with open surgical skills. Therefore, the Taiwan Society for Vascular Surgery (TSVS) organized a cadaveric open surgery workshop for TSVS, the Japanese Society for Vascular Surgery (JSVS), and the Tzu Chi International Medical Association in June 2020 at the venue of Tzu Chi Medical Simulation Center. This open surgery workshop utilizes various innovative teaching methods - lecture, virtual operation, and cadaveric simulation training. This study aimed to investigate whether a simulation-based cadaveric surgical program improves objectively assessed educational effects on the junior surgeons’ clinical operation skills, technical experience, and disease familiarity — a total of 40 participants engaged in this workshop, including 12 trainers and 28 trainees. Of the 28 trainees, only 24 sent in the questionnaires. The trainees’ three common job characteristics were as follows: 75% based in medical center, 62.5% attending surgeons, and 66.6% with less than five years of work experience. This study used trainees’ questionnaires to assess learner reactions. The outcome measures included learner opinion on the process of thoracoabdominal aortic open surgery familiarity, change in operative confidence, and self-perceived competency, all of which were improved significantly (p < 0.001) after the workshop. This cadaveric workshop was organized with international researchers and applied methods to engage participants in silent teacher mock operations. Hence, we must reconsider the indication and appropriate timing of endovascular intervention. “Making operations perfect” is the ultimate goal the training wishes to fulfill regarding medical care. With theories, knowledge, and skills, clinical surgeons can boost confidence towards thoracoabdominal aortic open surgeries, hoping that related cases in the future could receive proper and better care.
aortic aneurysms, endovascular repair, open repair surgery, innovative medical simulation training course, medical humanities