2012-08-012024-05-13https://scholars.lib.ntu.edu.tw/handle/123456789/653839摘要：本研究團隊擬以「以漸進性醫學模擬情境輔助臨床教學之規劃研究--以創傷處置教學為對象」為三年期教學計畫，本研究之源起一方面在於探討適合我國國情之醫學模擬教學架構，規劃輔助臨床教學之課程，另一方面則在於發展符合近年國際以漸進性醫學模擬情境教學輔助基礎與臨床教學銜接的趨勢。醫學模擬教育之源起原係因應臨床突發狀況處置之訓練，其後社會對醫療品質之期待日益提高，過去以病人為教學材料之臨床教育與民眾就醫權益之衝突備受關注，經多年之發展醫學模擬教育乃擴大演變為輔助臨床醫學教育之系統性課程。其優點除在於提供資淺醫謢人員對於臨床個案的學習，亦有在臨床學習過程中提供客觀評估學員臨床能力的重要意義。OSCE（Objective Structured Clinical Examination , 客觀結構式臨床能力測驗）為近年世界醫學教育重要課題，其核心內容是以客觀的方式評估臨床能力，試驗方式包含醫療面談及身體檢查的“技能”與“態度”的評估，特別是要維持其客觀性（objective）。其標準化病人之情境，可以使資淺醫護人員在模擬的情境能學習對臨床作業，然而標準化病人之訓練與成本仍為醫學教育上之重大門檻，以電腦化模擬假人之醫學模擬教育除能降低學習成本，並能隨學員之能力調整課程內容。本研究將以三年為期，仿歐美醫學教育先進國家於醫學教育中，規劃醫學模擬教育配合不同學習階段之OSCE課程，並探討如何修正課程內容有助於學生學習臨床重點。本院急診創傷處置教學已提高情境模擬教學之比重，使學生能在從事實際臨床作業前能熟悉基本觀念與技能之整合，歷年來發展醫學模擬教育之經驗，本研究團隊擬將創創傷處置教學從單一課程之教學，擴展為學生於本部參與臨床作業中，提供不同內容與重點之醫學模擬課程，以彌補學生因所接觸之臨床個案差異造成學習成果之參不齊，並能於學習期間客觀評估學生學習成果，提供學生適當之學習回饋。本研究除將規劃醫學模擬教育，並將積極與外界合作，擬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。<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 simulation-based, skill-focused medical eduction enables knowledge, skills and attitudes to be acquired for healthcare professionals in a safe, educationally orientated and efficient manner.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 health professionals. In order to improve the ability of trauma management in junior health professionals, we propose the "education and evaluation module for junior health professionals”as a possible supplementary component of fundamental education for junior health professionals who will participate in trauma resuscitation.Simulation-based education program could initially began with manikins and encompass an entire range of systems, from synthetic skills training modules through to hig fidelity simulation scenarios. These models can also be used for training procedure-based skills, communication, leadership and team working. However the level of simulation must be appropriate to the students's ability and can range from focused skill-training to multiple trauma scenarios. The developement of simulation education program is a global phenomenon and the curricula should be methodologically sound and cost-effective.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 more positive interest in trauma resuscitation, although the load of the instructors should be increased in respect of scheduled lectures.The study is designed to develop the exact role of simulation as a training mechanism for schollarly sklls, professionalism, management and health advocacy.