Title

影響醫師學習曲線之相關因子探討—以腹腔鏡膽囊切除手術為例

Translated Titles

A Study of the Related-factors that Affect the Surgeons’ Learning Curves¬¬: Using Laparoscopic Cholecystectomy as an Example

DOI

10.6342/NTU.2009.00948

Authors

陳之薇

Key Words

學習曲線 ; 腹腔鏡膽囊切除手術 ; 醫師認知 ; learning curve ; laparoscopic cholecystectomy ; surgeons’ perception

PublicationName

臺灣大學醫療機構管理研究所學位論文

Volume or Term/Year and Month of Publication

2009年

Academic Degree Category

碩士

Advisor

鍾國彪

Content Language

繁體中文

Chinese Abstract

背景與目的: 1987年第一例腹腔鏡膽囊切除手術(LC)完成後,開始出現探討腹腔鏡手術與學習曲線的研究,腹腔鏡手術會成為研究學習曲線的新興主題在於其不同於傳統的手術方式,以及其訓練模式造成的創新與衝擊。近年來對於影響醫師學習曲線因素探討的相關研究日益增加,但大多數研究是使用資料庫數據分析比較,這些較為片斷性的資料可能無法呈現出完整資訊,也無從得知手術醫師對於學習曲線影響因子的認知與看法;在台灣,針對手術的學習曲線建立及探討仍屬少數,究竟醫師要執行多少例手術能達到良好的手術結果,又有哪些因素會影響到醫師學習曲線,將是本研究欲釐清的幾個問題。 研究方法:本研究參考國內外相關文獻進行問卷設計,並透過三位專家學者進行效度檢測,最後根據前測結果對部分題項進行適度刪修完成定稿。本研究採用橫斷式研究,在透過公文與97家醫院聯繫後,經徵詢院方同意與進行倫理委員會審查,最後以10家醫學中心、20家區域醫院、4家地區教學醫院為個案醫院,主要研究對象為有執行腹腔鏡手術經驗或接受相關訓練的一般外科醫師,並於97年4月29日到97年6月22間進行問卷收發,共回收155份有效樣本。 研究結果: 研究結果顯示醫師對於執行幾例手術可以達到手術結果平穩良好狀態的認知從5例至100例,平均數為38例;經過卡方檢定與邏輯斯迴歸分析後發現,越有經驗或更多訓練背景與訓練模式的醫師對於達到學習曲線例數的認知是比較低的;手術時間的進步與「獨立完成開腹式手術數量」呈現顯著正相關,表示累積的手術數量將伴隨的手術時間的降低;併發症發生率的進步與「執行其他腹腔鏡手術情況」呈現顯著正相關,表示執行其他腹腔鏡手術的經驗對於手術結果有正向影響;新興科技訓練模式方式如「模擬儀器訓練」、「虛擬腹腔鏡系統訓練」、「教學錄影帶訓練」與學習曲線變項呈現顯著關係,表示這些訓練模式可以輔助或加速學習曲線。 建議:對於未來的研究建議包括:可以用縱貫式之研究方式,進行因果關係與不同時間點研究結果之比較確認;與個案醫院合作,利用相關手術紀錄進行分析比對,以了解實際影響醫師學習曲線之相關因素;將研究對象擴大至不同腹腔鏡手術或不同科別進行探究。

English Abstract

Introduction: The purpose of this study was to determine what effects the surgeons’ learning curve. The learning process of a surgeon seems to follow the learning curve; hence, there are abundance research about the relation between surgery procedures and learning curves. Recently, laparoscopic surgery is one of the most common topics examined among learning curve issues. This new surgery requires a different training program and has impact on the learning process of surgeons. In recent years, most related research based their analysis using database. As there were some limitations on the data period, the complete information may not have been represented. In addition, it is difficult to know the viewpoint and perception of surgeons based on the database. This study uses laparoscopic surgery as an example and was design to investigate the learning curve of surgeon by studying the important related-factors affecting the learning curve of surgeons. Methods: A three-page, 52-item questionnaire was developed after reviewing existing literatures and was modified by 3 experts and though pretest process. The questionnaire was designed to investigate the factors that have influenced the surgeons’ learning curves. This is a cross-sectional study. After looking for cooperation with hospitals and approved by some Institution Review Broad, there are 34 hospital included 10 academic medical centers, 20 regional hospitals, 4 district hospitals agreed to participate in this study. The participants of this study were general surgeons. There were 155 valid samples with collection period from April 29 to June 22, 2009. Results: The study results show how many procedures of laparoscopic cholecystectomies could pass the learning curve to achieve a steady performance from 5 to 100 in surgeons’ point of view, and average procedure is 38. After chi-square and logistic regression analysis, it shows that surgeons who are more experience or have receive more training program think that it does not need much procedures to reach the learning curve. It also shows that the improvement of operative time has significant positive related with the accumulated volumes of open surgery, and the improvement of complication rate has significant positive related with the experience of other laparoscopic surgery. In addition, it shows new technical training model such as surgical trainer, virtual reality simulator training and video cources have significant related with variables of learning curve, which indicates these training model do help and accelerate the learning curve. Recommendations:Recommendations for study in the future included: first, adopt longitudinal study to compare the result of different time points; second, cooperated with case hospital and use some clinical data to compare the result from objective and subjective viewpoint; third, using different laparoscopic surgery as an example to study the learning curve.

Topic Category 醫藥衛生 > 醫院管理與醫事行政
公共衛生學院 > 醫療機構管理研究所
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