2024-05-182024-05-18https://scholars.lib.ntu.edu.tw/handle/123456789/714902The Department of Surgery at National Taiwan University Hospital has a long history of being at the forefront of education, research, and clinical care and seek to improve in all areas of endeavor every year. The department serves as one of the major referral center in Taiwan, caring more than 15,000 inpatients per year. The department currently staffs 341 general beds plus 50 ICU beds and a burn center. There are approximately 50 full-time hospital–based faculty members and 66 practicing physicians who hold faculty appointments. The department also trains over 65 residents and fellows through residency programs in various divisions. The department consists of 7 divisions. Each of which maintains a distinct profile of patients care, research and teaching. The department encompasses division of cardiovascular surgery, thoracic surgery, neurosurgery, general surgery, pediatric surgery, plastic surgery and colorectal surgery. These divisions provides preoperative evaluation, operative and nonoperative management and postoperative care for patients with the widest variety of surgical disorders. Each year, more than 10,000 operative procedures are completed. The mission of the department is to provide excellent patient care in an environment that stimulates its faculty, trainees and students to constantly improve their patient care, teaching, learning and investigation abilities. In the area of patient care, the department continues to demonstrate excellence and national leadership in many areas, including open heart surgery, vascular surgery, hepatobiliary-pancrease surgery, gastrointestinal surgery, breast surgery, neurosurgery, thoracic surgery and organ transplantation. Many efforts has been done to improve the outcome of the surgical patients. For example: ECMO was used to support a patient with heart failure before or after heart surgery; mini-laparoscope was used to minimize the wound and discomfort of patients receiving laparoscopic surgery; endoscopic technique was used in the field of neurosurgery to shorten the recovery time of the patients. In the past, the department was known for its outstanding clinical base, featuring excellence in clinical care and teaching and was less prominent in the areas of clinical and basic research. Over the past few years, however, the department has increased dramatically the quality and quantity of its research effort. With about 24,000,000 NT dollars research grants more than 110 papers were published last year. A committee governing the usage of surgical laboratory was established last year. This help the staffs to do their research more easily and efficiently. The department now has laboratories for transplantation immunology, cell culture, molecular biology, animal experiment, pathology and physiology. Cooperation with other department in the medical school is encouraged to extend the field of surgical research. With respect to research opportunities, the department change the resident training course of some divisions for they can participate in a one or two year research program focused on the topic they are interested in. In the area of teaching, the department has grew as significantly as the area of clinical service and research. The department present more than 10 conferences and seminars per week in different division which are opened to anyone who wishing to participate. A core course of 100 important surgical topics was designed for the 5th year medical student since 1998, which help the student to be familiar to the basic knowledge of surgery. One to one teaching gives the students more chances to know the problems which may be encountered during clinical services. Efforts to increase the number of affiliated hospitals provide student and resident chances of training in different kinds of surgical subjects.日據時代，台大醫院外科分為第一及第二外科，各有一位教授、助教授及講師，其餘為助手及副手等，尚未有住院醫師訓練制度。隨著第二次世界大戰結束，日本籍教授們一一被遣送回日本，台籍醫師開始負起外科之行政事務。 【組織分科】 除上述七項主要之分科外，鑑於重症病患之加護照顧的重要，外科除了加強各加護病房的設備外，1996年也非正式成立了加護病房科，由柯文哲擔任主任，以強化病患之臨床照顧及醫護人員之訓練。因此，ECMO之使用及移植病患之術後照顧，均已得到更好的成績。另者，為了因應外科住院醫師訓練之完整需求，實驗外科也於1996年有了雛形，由林芳郁醫師負責訂定實驗室使用規章及實驗動物、器械之籌備，使外科住院醫師R1開始，便能培養動物實驗之實際經驗與研究基礎。 【教學制度】 外科對醫學院學生的教學，一直配合醫學院之教學制度，老師們也都相當盡心。由於手術佔用相當多時間的特質，醫學生的實習，需倚賴晨會討論、床邊迴診教學，以及開刀房實習等。 晨會討論制度自林天祐時代開始嚴格實施，歷經各任主任之沿革至今，每星期二、四之晨會為各分科個別舉行，需報告及討論前一日接受開刀病患之開刀結果，以及次日接受開刀病患之診斷及準備情形；星期二則為大外科Mortality及Morbidity病例討論會；另在星期四早晨7點開始有Grand round之病例討論，由各分科提出有教育性之併發症或死亡案例討論，學生均能受益良多，並報告一週來科內重要事務。床邊迴診教學，幾經沿革，1997年開始注入了國內首創之 "台大外科核心100" 課程，由各分科審慎選出100項外科臨床工作必備課程綱要，由專任主治醫師集中教學，提供學生在外科見習時，相當貼切的學習方針。在見習期間，有一星期為每個學生完全跟隨一位老師之 "導師制度" ，更使學生們瞭解外科醫師真實生活的一面，同時也能在學生們外科知識及生活上加以關心，給予學生們學習上更多的指導，頗獲好評。住院醫師是外科 "師徒" 制訓練相當重要的變革，台大醫院在傅斯年校長的推動下，於1949年開始了住院醫師訓練制度。當時進外科第一年稱為fixed intern，第二、三年為助理住院醫師，第四年為住院醫師，第五年是總住院醫師，開始時是金字塔式之升等方式，後來雖均改名為住院醫師，但第三年住院醫師開始需接受評估與淘汰，競爭難免。 至洪啟仁主任時，改為不淘汰，以協調與合作方式，人人均得以接受完整之外科訓練。朱樹勳主任時，因應各次專科醫學會專科醫師訓練之要求，小兒外科、神經外科、整形外科之住院醫師訓練改為6年，同時也改為第三年住院醫師開始，需選擇固定在各次專科，使各次專科之訓練得以提前，且有較長久而紮實之訓練。外科對住院醫師之訓練，除病患之開刀與照顧外，也相當重視研究與發表之訓練，如Grand round及Mortality & Morbidity討論會之發表與寫作，實驗外科之接觸等，都已列入成績考核項目中。 【結語】 台大外科之人才輩出，不勝枚舉。歷屆主任由林天祐、許書劍、洪啟仁、陳楷模、朱樹勳等，都曾任中華民國外科醫學會理事長，而各次專科醫學會理事長及理監事，許多都是台大外科同仁擔任。1991年醫學院首任選舉產生之院長，即由外科陳維昭教授當選榮任，兩年後（1993年）更高昇為台灣大學首屆普選校長，他也是台大史上第一位醫學院出身之校長，台大外科全體同仁均與有榮焉。 五十年來，台大外科已走過篳路藍縷的歲月，也表現出許多揚名全國、享譽國際的重大成就。如今在優良傳統、健全制度及尖端科技的帶領下，即將昂首邁向廿一世紀，尤其在全民健保實施之衝擊下，除教學、研究、服務的傳統任務外，成本效益與醫界競爭的考量，也加重了台大外科的責任。