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題 名 | 數位化模擬人在急重症實境模擬訓練的未來發展=Simulator Training in Acute Care Medicine |
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作 者 | 陳品堂; 尹彙文; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 5:4 2003.12[民92.12] |
頁 次 | 頁255-262 |
分類號 | 415.22 |
關鍵詞 | 模擬人; 實境; 急重症訓練; Simulator; Acute care medicine; Scenario; |
語 文 | 中文(Chinese) |
中文摘要 | 很多醫學文獻都指出有許多醫療過失是由於人為的疏失及臨床技術不熟練所造成的。依據統計,美國每年有44,000至98,000人死於醫療過失,其死亡人數遠超過機動車意外事故、乳癌及愛滋病患者的死亡人數。自從血氧濃度監測器(pulse oximeter)發明以來,實境模擬(scenario simulation)曾經被認為是醫學教育上最重要的進步。 病人的風險常是複雜、多度的、尤其像麻醉、手術、急診及重症加護等,這些急重症照護的臨床工作有賴於迅速正確判斷和第一時間完成技術操作,才能保障病人的安全,減少併發的風險。模擬人除了可以作為基本技術訓練外,也可用來操作極其複雜、多度的急重症照護病情,經由這種真實情境模擬可以完成正確有效的處置訓練。使用模擬人的優點:不會影響病患安全與隱私權;劇情模擬時可容許錯誤的判斷及不正確之技術操作;可重複呈現一般或罕見的急重病危機劇情,由個人或小組成員來治療模擬人;在逼真的模擬環境中,可以使用各類複雜的臨床儀器及設備;在模擬過程中可暫停操作以供臨場的即席討論,或重新模擬正確示範,或改以替代的處理方式及技術來重新演練。 迄今,新一代的飛行模擬器已經逼真至和真實飛行器無法區分。許多航空公司更要求飛行員必須完成所有的飛行模擬器技術訓練,並且每半年都要參加不同的空安模擬訓練以保持操作水準。由於目前資訊技術及精緻工業的快速成長,加速了二十一世紀之後,更逼真完美、符合需求的模擬人的問世!1980年代中期,逼真的模擬人和急重症訓練課程才漸被重視,迄今已經有超過150個模擬人在全世界的教育訓練使用中,以訓練及決斷(decision-making)為目的,目前超過1/3的美國醫學院擁有模擬人的模擬訓練中心,每年也有愈來愈多類似的中心成立,突部分都是用來作為訓練及教育。 過去的幾年中,醫學教育有著顯著的改革進步。許多醫學院及醫院正逐漸改變傳統的教育訓練方式,從舊式“see one, do one, teach one”的訓練模式轉變成成模擬實境的整合教育。日後“模擬人”以醫學教育及病患安全的觀點,可能會逐漸取代部份的傳統教育方式。希望模擬人的引進能將臺灣的醫學教育訓練,有關急重症及氣道訓練這一環節,帶向一個新紀耴,也希望這個模擬訓練器能替病人們營造一個更安全的就醫環境。 |
英文摘要 | Teaching and learning have been undergoing conceptual change everywhere. Acute-care realities of the specialties, such as anesthesia, emergency and intensive care medicine, are complex and dynamic. They depends on technical skills in a timely manner. Therefore simulators can be used not only for basic skills training (task training) but also for the practice of complicated scenario. Just like that many airlines permit pilots to fly aircraft only after they demonstrate their skill in a simulator. Simulation is the artificial condition of sufficient components of a real-world domain to achieve a specified goal. Fidelity refers to the accuracy with which the simulator reproduces the domain. Medical simulators in use now vary in their characteristics and fidelity. Traditional training devices of intermediate fidelity, such as the Laerdal Intubation Mannequin or Central Venous annulations Mannequin, allow users to learn skills for a specific purpose prior to patient contact. They can also be used in allied health industries to achieve various goals, such as, public education, clerk, intern and nursing on-job training. So the future of medical simulation is promising. One third of US medical schools have acquired a simulator for the training course in acute care. In conclusion, simulators could definitely be not worse than oral tests. The simulator is becoming an integral parts of a customized center to supplement hospital-based learning for medical students, interns, residents, surgeons, emergency physicians and intensive care physicians. And simulation has been proved to have four advantages of simulation including: 1. Protect patient safety or confidentiality. 2. Errors can be allowed and corrected by repeated practice. 3. The simulation environment allows testing of complex scenario in a realistic setting. 4. Discussion can be initiated anytime during the scenario, or “replayed” to demonstrate standard management or skill. |
本系統中英文摘要資訊取自各篇刊載內容。