以病人模擬器進行急重症醫療處置訓練

Management of Critically Ill Patients: A Training Program Using Human Patient Simulators

10.6145/jme.200606_10(2).0005

楊惠文(Hui-Wen Yang)；陳品堂(Pin-Tarng Chen)；陳隆景(Lung-King Chen)；黃英哲(Ying-Che Huang)；巫春蓮(Chun-Lien Wu)；程雅琳(Ya-Lin Chen)；尹彙文(Huey-Wen Yien)；郭正典(Cheng-Deng Kuo)；陳祖裕(Cho-Yu Chan)

高級心臟救命術 ； 急重症病患 ； 病人模擬器 ； advanced cardiac life support ； clinical skills resources center ； critically ill patients ； human patient simulator

Journal of Medical Education

10卷2期（2006 / 06 / 01）

126 - 134

繁體中文

為促進新進醫護人員對臨床醫療處置的能力，台北榮民總醫院於2003年成立臨床技術訓練中心（以下簡稱本中心），並設置二具病人模擬器（human patient simulator，Laerdal公司出品之SimMan），以提供醫護人員急重症醫療處置之訓練。在本中心應用病人模擬器的流程中，以實習醫師急重症訓練最為周詳與完整，自2004年7月至2005年10月共有170位實習醫師完成此項訓練。訓練課程之前置作業包括挑選真實病患改寫成教案，設計演練流程及製作演練程序說明光碟等。演練過程包括：演練流程說明、演練全程錄影及即時回饋。每次演練由三至四名實習醫師組成一個急救小組進行模擬演練，學員完成演練後均填寫一份問卷，以提供本中心作為改善演練流程之依據。結果發現對於課程的硬體環境設施有95位學員(56%)覺得設備精良；82位學員(48%)表示模擬情景逼真，非常有臨場感。對於課程所學習到的內容（知識、技能、態度）有98位學員(58%)覺得在急救的基本動作及高級心臟救命術(advanced cardiac life support, ACLS)的處置流程獲得進步；有72位學員(42%)覺得此課程可增加臨床及實戰的經驗，與平時在書本上所獲得的知識與作法有不同的體驗；有42位學員(25%)覺得在急救過程中獲得新的體驗及態度。整體而言，此訓練課程之初步成效獲師生一致肯定，而且大多數參與訓練的學員都希望能有更多受訓的機會，顯示大多數學員對於模擬訓練課程感到有用但並不足夠。提供更多學習的機會及設計更完善的演練流程是我們目前努力的目標。

To improve the clinical competency of medical students, junior residents and nurses, the Clinical Skills Resources Center (CSRC) of Taipei Veterans General Hospital was equipped with two patient simulators (SimMan(, Laerdal, Stavanger, Norway). A training program in the management of critically ill patients for intern doctors is currently the most refined program at our CSRC. Before the implementation of this program, the CSRC formulated several teaching cases originating from selected real patients, designed the rehearsal process and developed a video introduction to the process. The course included an introduction to the rehearsal process, practice in the management of critical conditions with video recording, and immediate feedback from senior instructors with the help of videotapes. From July 2004 to October 2005, a total of 170 intern doctors completed the course and filled out a questionnaire. Ninety-five (56%) of them appreciated the facilities of the training program; 82 (48%) were impressed by the reality of the environment; 98 (58%) agreed that their knowledge and skills in advanced cardiac life support (ACLS) had significantly improved; 72 (42%) felt that it was a distinctive learning experience; and 42 (25%) of the stated that they had learned new concepts in critical care. In conclusion, this training program was highly praised by both students and instructors. The promotion of this training program has become one of the current missions of the CSRC.

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