顳骨手術擬真教學訓練的進階策略

Step-wised Strategy in Simulation Temporal Bone Surgical Training

陳雅惠(Ya-Hui Chen) ； 黃淑暖(Shu-Nuan Huang) ； 王拔群(Pa-Chun Wang) ； 方德詠(Te-Yung Fang)

《台灣擬真醫學教育期刊》 2卷2期 (2016/02) Pp. 23-29

https://doi.org/10.6582/JTSSH.2016.2(2).03

摘要

背景與目的：醫學擬真訓練已經被廣泛運用在多個專科領域，尤其使用在耳鼻喉科立體構造複雜的顳骨解剖教學上特別實用。本院Harvey耳鼻喉科基礎研究實驗室是為增加顳骨研磨的相關經驗，期望能透過追蹤調查擬真顳骨解剖教學訓練之成效，更進一步了解對於每位住院醫師學習上的幫助。研究方法：7名住院醫師分別於2013年7月與2014年4月參與兩次訓練與評量，評量項目共包括重要結構破壞程度評分、教學步驟評分、整體模擬手術表現評分三類。除了呈現分布情況外，也希望能了解住院醫師等級、不同擬真顳骨解剖教學方法是否有分數上顯著的差異性存在，並且呈現住院醫師在前後受訓兩次是否有真正進步。研究結果：重要結構破壞程度評分顯示擬真顳骨解剖教學確實對於住院醫師在熟悉顳骨解剖操作有加分的效果； 在操作步驟平均分數與整體模擬表現平均分數上，大體顳骨最高分，塑膠顳骨其次，電腦顳骨較差；資深住院醫師之整體表現分數都高於資淺的住院醫師(P＜0.05)；而第二次訓練分數雖然都高於第一次分數，但在操作步驟評分上並無顯著意義。結論：不同的擬真顳骨解剖教學方法對於住院醫師學習顳骨構造都有不同助益，應依照住院醫師經驗等級使用不同教學方法，且教學訓練不宜間隔太久以免降低熟悉程度。

關鍵字

顳骨 ； 醫學教育 ； 擬真訓練

並列摘要

Objectives: Medical simulation education has been used in many specialties, particularly useful in teaching complex anatomy of temporal bone (TB). Harvey ENT Basic Research Laboratory was established to increase TB dissection training. Aims of this study are to evaluate and to know the effectiveness of TB simulation education for residents. Methods: A total of 7 residents were trained and evaluated in July, 2013 and in April, 2014.The scores included three sections: collisions to important structures, performance of each TB dissection procedures, and overall surgical skill evaluation. The level of the residents, the TB simulation methods, and the before-after test scores were compared to know the differences. Results: It showed improvement in their comprehension to TB anatomy training. The residents who dissected cadaveric TB had best scores in performance of dissection procedures and in overall surgical skills, while they had worst scores when using computer simulation. More experienced residents had higher scores (P＜0.05). Though the training scores of the second time had better than the first time, but it showed no significant improvement in the performance scores of the TB dissection procedures. Conclusions: Different teaching TB anatomy simulation methods have different efficiency for each resident. It should depend on their experiences to use suitable simulation training methods. And the interval between each simulation training programs should not too long to enhance the proficiency of the training.

並列關鍵字

temporal bone (TB) ； medical education ； simulation training