電子假人在危急病例處置之教學應用

A Mannequin-based Simulation for Teaching Emergent Crisis Care

10.6145/jme.200606_10(2).0004

蔡淳娟(Tsuen-Chiuan Tsai)；張倍榮(Pei-Jung Chang)；方詩元(Shin-Yuan Fang)；林其和(Chyi-Her Lin)

擬真 ； 醫學教育 ； 急診 ； 評量 ； 休克 ； 呼吸窘迫 ； simulation ； medical education ； emergency ； assessment ； shock ； respiratory distress

Journal of Medical Education

10卷2期（2006 / 06 / 01）

115 - 125

繁體中文

Teaching medical students to appropriately manage critical cases is, typically, quite a challenge, such students usually having limited opportunity to demonstrate prompt patient assessment, rapid decision making and accurate management for ”real” patients. A simulation that uses a mannequin for repeated practice of clinical skills and experimentation in patient care in a controlled, safe learning environment is one apparent solution to such a problem. This study was intended to determine the (student) learning gains derived from experience with a mannequin-based simulation as part of teaching year-6 medical students and PGY 1 (Postgraduate year one) residents as regards the appropriate management of critical patients. 0 DQG This study featured a case-control pretest-posttest design. We used a Laerdal SimMan mannequin herein, in order to simulate dealing with real patients suffering from shock and/or respiratory distress. The individuals participating in this study were year-6 medical students and PGY 1 residents, who were randomly divided into one of two groups: one which featured study participants who underwent simulation-based training and who were pre- and posttested for simulation performance, the other featuring participants who did not undergo such training. A specific measurement tool was used to assess participants' psychomotor and behavioral scores for performance by two independent qualified raters. 5H VXQV A total of 60 participants were enrolled into this study, and a total of 120 simulations were undertaken, such an exercise yielding 204 valid test scores (51 individuals participating in 102 scenarios of shock/respiratory distress as determined by two independent raters. Participants (16 year-6 medical students and 35 PGY 1 residents) were deemed incompetent in pre-test as regards the following items: endotracheal intubation, delivery of CPR, demonstrating an acceptable time period for initiating treatment and vigilance. The performance scores did not appear to be significantly different between pretest and posttest situations, although posttest scores were generally greater than corresponding pretest scores. For the experimental group, ie the group, the members of which underwent mannequin training, significant learning gains were apparent (ie as evidenced by the difference between such individuals' pretest and posttest scores) for 14 separate items (p＜0.05), however, when compared to the control group, the learning gain for members of the experimental group was significantly greater for only one item (decision-making as regards the necessity, or otherwise, for endotracheal intubation). &RQ FOXVLRQ The simulation training program referred to herein has been successful as regards identifying young physicians' problems and also as regards appropriate teaching of individuals for appropriately managing critical cases. Further modifying the simulation scenarios with appropriate difficulty level to enhance learning in emergent crisis care is clearly warranted.

Teaching medical students to appropriately manage critical cases is, typically, quite a challenge, such students usually having limited opportunity to demonstrate prompt patient assessment, rapid decision making and accurate management for ”real” patients. A simulation that uses a mannequin for repeated practice of clinical skills and experimentation in patient care in a controlled, safe learning environment is one apparent solution to such a problem. This study was intended to determine the (student) learning gains derived from experience with a mannequin-based simulation as part of teaching year-6 medical students and PGY 1 (Postgraduate year one) residents as regards the appropriate management of critical patients. 0 DQG This study featured a case-control pretest-posttest design. We used a Laerdal SimMan mannequin herein, in order to simulate dealing with real patients suffering from shock and/or respiratory distress. The individuals participating in this study were year-6 medical students and PGY 1 residents, who were randomly divided into one of two groups: one which featured study participants who underwent simulation-based training and who were pre- and posttested for simulation performance, the other featuring participants who did not undergo such training. A specific measurement tool was used to assess participants' psychomotor and behavioral scores for performance by two independent qualified raters. 5H VXQV A total of 60 participants were enrolled into this study, and a total of 120 simulations were undertaken, such an exercise yielding 204 valid test scores (51 individuals participating in 102 scenarios of shock/respiratory distress as determined by two independent raters. Participants (16 year-6 medical students and 35 PGY 1 residents) were deemed incompetent in pre-test as regards the following items: endotracheal intubation, delivery of CPR, demonstrating an acceptable time period for initiating treatment and vigilance. The performance scores did not appear to be significantly different between pretest and posttest situations, although posttest scores were generally greater than corresponding pretest scores. For the experimental group, ie the group, the members of which underwent mannequin training, significant learning gains were apparent (ie as evidenced by the difference between such individuals' pretest and posttest scores) for 14 separate items (p＜0.05), however, when compared to the control group, the learning gain for members of the experimental group was significantly greater for only one item (decision-making as regards the necessity, or otherwise, for endotracheal intubation). &RQ FOXVLRQ The simulation training program referred to herein has been successful as regards identifying young physicians' problems and also as regards appropriate teaching of individuals for appropriately managing critical cases. Further modifying the simulation scenarios with appropriate difficulty level to enhance learning in emergent crisis care is clearly warranted.

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