2011-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/649246摘要：本研究計劃係「以模擬情境教學提升資淺醫療人員對創傷病患的處置」之第三年延續性計畫，本研究計劃執行迄今已依第一年研究成果將情境模擬引入創傷處置教學，並於第二年度起依資淺醫護學員程度規劃創傷處置課程，第三年度並將修正前兩年研究執行結果，將情境模擬從臨床能力評量轉而作為臨床學習的預習，讓情境模擬從評量的工具推廣為一般常規教學的架構。本研究執行迄今，國內對臨床教學之規劃已有大幅修正，PGY100之制度變革與OSCE（Objective Structured Clinical Examination , 客觀結構式臨床能力測驗）未來將引入國家醫護考試第三階段臨床評量均為我國醫學教育上力求配合臨床作業而發展，本研究配合國家政策之發展，針對創傷病患處置提供學生正確了解臨床操作核心觀念與重要技能；並因應未來學制之改變，嘗試以情境模擬配合不同學習階段之需求，使學生（實習醫學生、實習醫師、PGY住院醫師、護理師、與專科護理師）學習重點能有區分。目前本院急診創傷處置教學，已因本研究而漸次朝向提高情境模擬教學之比重，利用情境模擬教學，誘使學生能注意到臨床創傷病患處置上的觀念，實習醫學生之教育規劃集中於一般理學檢查與緊急處置程序之熟悉，單項技術操作除維持一般常規教育訓練外，亦於情境模擬中測試學生學習成果;實習醫師之教育規劃則以數位影音資料提供學生預習，臨床操作前之創傷處置教育則由情境模擬來測試學生觀念與能力，並隨機安排實習醫學生與實習醫師混合教學，透過實習醫師監督及指導實習醫學生模擬操作的方式，讓醫師熟悉創傷處置團隊合作的默契;護理師之創傷教育訓練，一方面提供其相關資料，於常規臨床晨會中安排教學，另一方面則給予相關臨床基礎創傷處置觀念(primary survey and resuscitaiton, 初級評估與急救)flowchart與操作之checklist，俾使護理人員在創傷處置上，從傳統接受指令擴大為臨床上監督處置流程，以提高醫療品質;專科護理師之創傷教育訓練，除應完成護理師之學習外，另外亦配合臨床訓練年限，給予類同於實習醫學生及實習醫師之訓練。本研究亦積極與外界合作，除派員參與國內重要醫學教育研習，並廣泛與專家學者交換意見外，亦尋求與各國先進醫學教育研究機構及學會交流，俾促成創傷醫學教育之長久發展，研究執行迄今，除與國內各醫學中心及醫學院廣泛交流外，亦已與Harvard Medical School Medical Simulation Center、Harvard Medical School-Cambridge Integrated Clerkship program 及Wilson centre for research in education at the university health network, University of Toronto之負責人協商未來合作研究。<br> Abstract: Traditional clinical trauma management education programs are organized according to anatomy categories or focus on multiple organs injuries. The organization of basic clinical trauma management learning programs in emergency department, however, might shift emphasis to the presenting fundamental concepts and simple clinical skills that initiate the clinical encounter. The scenario-based, skill-focused approach is a significant innovation in trauma education and practice.The Formosa Association for the Surgery of Trauma, the Taiwan Society of Emergency Medicine, and the National Taiwan University Hospital have reported on the success of the standard ATLS program for physicians since the introduction of the Advanced Trauma Life Support (ATLS) program to Taiwan in the 1996. It has generally been recognized that the success of trauma resuscitation is partly relied on team cooperation and the core concepts of the ATLS should be practically applied during the resuscitation of trauma patients. However, the standard ATLS courses focus on management of sever trauma patients and are only well appreciated by senior medical staffs. In order to improve the ability of trauma management in junior medical staffs, we propose the "education and evaluation module for junior physicians”as a possible supplementary component of fundamental education for junior medical staffs who will participate in trauma resuscitation.This study consists of, first, the recognizing of fundamental concepts and several basic clinical skills of trauma resuscitation. After organizing the core concepts of trauma management education programs for junior medical staffs, the teaching materials have been reviewed by the committee from the faculty of emergency department and educational department of medical college of the National Taiwan University Hospital. Discussion and clinical teaching exercises ensues focusing on the mistakes frequently committed by the junior medical staffs and how there errors could be prevented through pre-clinical teaching program.Second, the teaching programs were launched in regular clinical education schedule. The feedback of students and didactic comments were filed as a reference for the reorganization of the education program. The fundamental clinical skills were included in the teaching program through these process. Digitalized education programs were also available on internet for students that could not participate in the regular education program.After lectures focusing fundamental trauma resuscitation concepts, the students will have the opportunities to participate the workshop focusing on the basic clinical skills in trauma resuscitations. Third, after the lectures and workshops, the students will participate the scenario-based trauma resuscitation tests. The instructors will give necessary information according to the decision of the members and evaluate the performance of the members.It is evident that the integration of core concepts of trauma managements and the clinical skills facilitates and encourages the development of clinical thinking and decision making. However, there are some important issues should be noticed. First, as the number of lectures is reduced and scenario-based, skill-oriented tasks are introduced instead, a higher level of physician responsibility for individual learning is required. Randomized trauma cases would still be one of the major challenges. Second, scenario-based teaching, repeated practices and tasks in minor trauma patients are necessary to give the physicians a better understanding of the fundamental concepts and clinical skills of trauma resuscitation. From this base the physicians will be enabled to discuss and understand the decision making in different stages of the possible scenarios. Third, experience and results show that physician performance in trauma management improved significantly, that physicians acquired a better understanding and a more comprehensive grasp of the clinical judgments and clinical skills, and a noticeably morepositive interest in trauma resuscitation, although the load of the instructors should be increased in respect of scheduled lectures.基本創傷處置教育情境模擬教學