「建構式外科技能訓練模式」對培養外科住院醫師能力之成效

The Effect of a Structured Skill Training Model for Cultivating Surgical Competency

葉啟娟(CHI-CHUAN YEH)

指導教授 ： 何榮桂

國立臺灣師範大學/教育學院/創造力發展碩士在職專班/碩士(2012年)

摘要

一直以來，外科系住院醫師的養成教育多採用學徒制度模式，因著醫療科技的大幅進步、醫療經濟學的發展、疾病嚴重度的增加、以及社會大眾的高度期待，過去十年，國外在外科醫學教育這方面有大幅度的進步，主要是導入能力為基礎的新外科教育模式，企圖在工作時數限制及臨床學習機會減少的困境下，藉由在外科技術實驗室推動建構性訓練課程，培養新一代外科醫師具備良好的臨床能力。本研究是關於「建構式外科技能訓練模式」--結合基礎手術訓練及進階動物實驗訓練，在新設立的台大醫院微創手術訓練中心進行，藉由多項評估方式，評估課程成效、臨床表現、以及對外科醫師養成能力的影響三個方面的訓練成果，採量化及質性混合型研究設計，找出此一嶄新的訓練模式，對住院醫師在外科醫師能力培養的影響因素。研究結果顯示，本研究提出的「建構式外科技能訓練模式」，的確能達到培養外科能力之目的。所培養的能力包括各項基本及進階手術技能、領導能力、團隊合作能力、教學能力，因此，不僅增進外科第一、二年住院醫師的基本手術能力及對自我能力了解的程度，也提升了其成為一位優秀的外科醫師的自信心。關於「建構式外科技能訓練模式」培養的基本手術能力與臨床表現的關係，本研究量化結果僅發現動物實驗縫合整體表現和門診手術第四週評估皮下腫瘤切除整體表現，有高度相關，但訪談結果可佐證，在無壓力可以討論的學習環境中，藉由設計良好的訓練課程，本訓練模式所培養的基本手術能力是能運用到臨床工作中。「建構式外科技能訓練模式」能提升住院醫師成為優秀外科醫師的自信心，是一個有效且具培養多種能力的訓練模式。

關鍵字

以能力為基礎的外科教學 ； 外科教學 ； 外科技術訓練

並列摘要

Competency-based surgical training models with hands-on skills training in surgical skills laboratories are the new trend for cultivating new surgeons. We assessed the effect of the new National Taiwan University Hospital Structured Surgical Skill Training Model (NTUH SSSTM) on the development of young surgeons’ competencies. We set up new basic surgical skills (BSS) training workshops in Minimally Invasive Surgery Training Center, NTUH in 2008, which combined to advanced animal experiments for junior residents as the NTUH SSSTM. The BBS training workshops included basic surgical skills, small bowel anastomosis, subcutaneous tumor excision and usage of auto-suture devices. Junior residents performed diagnostic laparoscopy and subtotal gastrectomy on pigs and performed exploratory laparotomy 2 weeks later. Mixed method reseach was conduted included self-evaluated questionares for both training courses, sugical skills assessment forms for suturing, kot tying, bowel anastomosis, subcuteneous tumor excision, an interview study for the trainees, and a group discussion for the trainers.

The results of self-evaluated scores of both courses showed the young trainees gained competency significantly in performing basic and advanced surgical skills. The competences which included basic and advanced surgical skills, leadership, teamwork, and teaching ability were cultivated in this training model. Young surgical trainees and surgical trainers thought these competences could be implemented in the clinical setting. In conclusion, the National Taiwan University Hospital Structured Surgical Skill Training Model was an effective model which could cultivate multiple competences in order to increase a young surgical trainee’s confidence in order to become an excellent surgeon in the future.

並列關鍵字

Competency-bases surgical training ； surgical education ； surgical skills training

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