病人為焦點模擬訓練在外科手術縫合的全人醫療教學應用

The Application of Patient-focused Simulation to Teach Surgical Suturing Skills in Bio-psycho-social Medicine

林姵君(Pei-Chun Lin) ； 簡維宏(Wei-Horng Jean) ； 陳巧倫(Chiao-Lun Chen) ； 陳芸(Yun Chen) ； 鄭國祥(Kuo-Shyang Jeng) ； 朱樹勳(Shu-Hsun Chu)

《Journal of Medical Education》 13卷3期 (2009/09) Pp. 191-198

https://doi.org/10.6145/jme.200909_13(3).0005

摘要

本研究利用病人為焦點模擬訓練訓練(Patient-focused simulation)方式，藉由融合與標準病人醫病溝通技巧與傷口縫合來教授與評估醫師對於將全人醫療觀念應用在技能操作的訓練。我們以97學年度在本院受訓的實習醫師為主要的教學對象。授課方式為以不超過六人的小組教學方式，先利用實際模具演練的方式教授縫合與練習。在確定同學都可掌握縫合技巧後，推派其中一位參加這項標準病人手術縫合模擬課程。標準病人扮演一位視障者，因為導盲犬生病而獨自出門上班因而跌倒受傷，病患帶著墨鏡躺在病床上，左手揹負撕裂傷的假皮模具，並且以手術洞巾覆蓋以求逼真。評分方式比照OSCE(objective structured clinical examination)教案。結果發現66.67%的受測學員在完成縫合的整個過程渾然不覺病患是視障者。評估表包括三個面項，各五小項，滿分10分。第一大項的問診開始的自我介紹，同學平均分數為8.56分，第二大項醫病溝通建立正面的醫病關係，平均8.2分，三是臨床技術操作評量平均8.89分最高。同學們在錄影回放與檢討回饋時知道病患是視障者時留下深刻印象，也能體認全人醫療照顧對於病人疾病康復的重要。由這個研究的結果，我們認為利用病人為焦點模擬訓練的模式可以做為未來技術性的操作教學的模式，更可以融入全人醫療照護的教學，培養注重以病人為中心的好醫生，增進全人照護的品質。

關鍵字

病人為焦點模擬訓練 ； 外科手術縫合 ； 全人醫療照護教學

並列摘要

Patient-focused simulation provides a more authentic environment for practice of clinical skills than a simulator-based training environment. In this paper, we utilized a patient-focused simulation to teach surgical suturing skills. We also assessed the competence of students in doctor-patient communication and their professionalism during the suturing process using a standard patient wearing a suturing simulator. The students had received internship training at our hospital from June 2008 to July 2009. Each class had fewer than 6 students. In the first stage a simulator was used to teach and practice surgical suturing skills. After the students could handle the fundamental suturing technique, one of the students was chosen for a demonstration on a standard patient using patient-focused simulation. The scenario was a blind woman who was injured on her way to the office in the morning. Her guide dog was sick, so she was walking alone and fell. She wore sunglasses, had a simulated wound on her left arm, and was lying down in the emergency room. A nurse cleaned, prepped, and draped the wound. The student’s task was to suture the wound. The results showed 66.67% of the students did not know the patient was blind after the whole process. The assessment included three parts, the introduction, doctor-patient communication, and suturing skills. Each part contained 5 tests with a full score of 10. The mean score for the first part (introduction) was 8.56, the second part (communication) was 8.2, and the third part (skills) was 8.89. After video recall and group discussion, many of the students were very surprised when they discovered the patient was blind. As a result, they realized the importance of the bio-psychosocial status of the patient and how that status is involved in disease recovery. Our scenarios can be a good model for training procedural skills and can cultivate patient-centered medical care.

並列關鍵字

patient-focused simulation ； suturing skills ； bio-psycho-social medicine

參考文獻

Kneebone R,Scott W,Darzi A(2004).Simulation and clinical practice: strengthening the relationship.Med Educ.38,1095-1102.

Kneebone R,Nestel D,Wetzel C(2006).The human face of stimulation: patient-focused simulation training.Acad Med.81(10),919-924.

Balack S,Nestel D,Horrocks E(2006).Simul Healthc.

Liao SC,Lee MB,Hsieh BS(2005).Medical service satisfaction and the physician-patient relationship: a national survey via computer–assisted telephone interviews.J Med Education.9,149-161.

Stewart M,Brown JB,Boon H(1999).Evidence on patient-doctor communication.Cancer Prev Control.2,25-30.