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高擬真情境模擬在住院醫師急重症訓練的應用:台大醫院的經驗

High-fidelity Simulation Applied during Critical Care Training of Residents at National Taiwan University Hospital

摘要


Much emphasis has been placed on patient safety since the publication of several studies reporting on the incidence of medical errors. In the 1999 Institute of Medicine's report <||>To err is human: Building a Safer Health System<||>, the magnitude of medical errors was pointed out, and a more efficient and safer education model including the use of simulation was highly recommended. In 2007, a critical care training course using high-fidelity simulation for the junior residents of internal medicine before their clinical practice in an intensive care unit was designed at National Taiwan University Hospital. Trainees were assessed by standardized written tests before (Pre-test) and after the course (Post-test), and by scenario-based essay questions (EQ1~4) after each simulation session. Between April and July 2007, a total of 52 first-year residents of the internal medicine department attended the course. The trainees' self-assessments of their own abilities in critical care knowledge, clinical judgment and management were found to have significantly improved after the course. Most of the trainees thought that receiving critical care training involving high-fidelity simulation is essential for residents before their clinical practice in an intensive care unit. Incorporating high-fidelity simulation into traditional didactic lectures during the residents' critical care training is an effective and valuable training model to improve trainees' self-confidence as well as their performance in terms of knowledge, clinical reasoning and skills. High-fidelity simulation is highly recommended and ought to be included in the critical care training of residents regularly.

並列摘要


Much emphasis has been placed on patient safety since the publication of several studies reporting on the incidence of medical errors. In the 1999 Institute of Medicine's report <||>To err is human: Building a Safer Health System<||>, the magnitude of medical errors was pointed out, and a more efficient and safer education model including the use of simulation was highly recommended. In 2007, a critical care training course using high-fidelity simulation for the junior residents of internal medicine before their clinical practice in an intensive care unit was designed at National Taiwan University Hospital. Trainees were assessed by standardized written tests before (Pre-test) and after the course (Post-test), and by scenario-based essay questions (EQ1~4) after each simulation session. Between April and July 2007, a total of 52 first-year residents of the internal medicine department attended the course. The trainees' self-assessments of their own abilities in critical care knowledge, clinical judgment and management were found to have significantly improved after the course. Most of the trainees thought that receiving critical care training involving high-fidelity simulation is essential for residents before their clinical practice in an intensive care unit. Incorporating high-fidelity simulation into traditional didactic lectures during the residents' critical care training is an effective and valuable training model to improve trainees' self-confidence as well as their performance in terms of knowledge, clinical reasoning and skills. High-fidelity simulation is highly recommended and ought to be included in the critical care training of residents regularly.

參考文獻


楊惠文、陳品糖、陳隆景(2006)。以病人模擬器進行急重症醫療處置訓練。醫學教育。10,126-134。
Baker GR,Norton PG,Flintoft V(2004).The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada.CMAJ.170,1678-1686.
Bloom BS(1956).Handbook I: The cognitive domain.New York:David McKay Co Inc..
Boulet JR,Murray D,Kras J(2003).Reliability and validity of a simulation-based acute care skills assessment for medical students and residents.Anesthesiology.99,1270-1280.
Brennan TA,Leape LL,Laird NM(1991).Incidence of adverse events and negligence in hospitalized patients.Results of the Harvard Medical Practice Study I. N Engl J Med.324,370-376.

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