高擬真情境模擬在住院醫師急重症訓練的應用：台大醫院的經驗

High-fidelity Simulation Applied during Critical Care Training of Residents at National Taiwan University Hospital

10.6145/jme.200809_12(3).0002

楊志偉(Chih-Wei Yang)；古世基(Shih-Chi Ku)；蔡詩力(Shih-Li Tsai)；葉啟娟(Chi-Chuan Yeh)；馬惠明(Huei-Ming Ma)；張上淳(Shan-Chwen Chang)

情境模擬 ； 急重症醫學教育 ； 住院醫師訓練 ； high-fidelity simulation ； medical education ； critical care training ； residency training

Journal of Medical Education

12卷3期（2008 / 09 / 01）

11 - 20

繁體中文

Much emphasis has been placed on patient safety since the publication of several studies reporting on the incidence of medical errors. In the 1999 Institute of Medicine's report ＜||＞To err is human: Building a Safer Health System＜||＞, the magnitude of medical errors was pointed out, and a more efficient and safer education model including the use of simulation was highly recommended. In 2007, a critical care training course using high-fidelity simulation for the junior residents of internal medicine before their clinical practice in an intensive care unit was designed at National Taiwan University Hospital. Trainees were assessed by standardized written tests before (Pre-test) and after the course (Post-test), and by scenario-based essay questions (EQ1~4) after each simulation session. Between April and July 2007, a total of 52 first-year residents of the internal medicine department attended the course. The trainees' self-assessments of their own abilities in critical care knowledge, clinical judgment and management were found to have significantly improved after the course. Most of the trainees thought that receiving critical care training involving high-fidelity simulation is essential for residents before their clinical practice in an intensive care unit. Incorporating high-fidelity simulation into traditional didactic lectures during the residents' critical care training is an effective and valuable training model to improve trainees' self-confidence as well as their performance in terms of knowledge, clinical reasoning and skills. High-fidelity simulation is highly recommended and ought to be included in the critical care training of residents regularly.

Much emphasis has been placed on patient safety since the publication of several studies reporting on the incidence of medical errors. In the 1999 Institute of Medicine's report ＜||＞To err is human: Building a Safer Health System＜||＞, the magnitude of medical errors was pointed out, and a more efficient and safer education model including the use of simulation was highly recommended. In 2007, a critical care training course using high-fidelity simulation for the junior residents of internal medicine before their clinical practice in an intensive care unit was designed at National Taiwan University Hospital. Trainees were assessed by standardized written tests before (Pre-test) and after the course (Post-test), and by scenario-based essay questions (EQ1~4) after each simulation session. Between April and July 2007, a total of 52 first-year residents of the internal medicine department attended the course. The trainees' self-assessments of their own abilities in critical care knowledge, clinical judgment and management were found to have significantly improved after the course. Most of the trainees thought that receiving critical care training involving high-fidelity simulation is essential for residents before their clinical practice in an intensive care unit. Incorporating high-fidelity simulation into traditional didactic lectures during the residents' critical care training is an effective and valuable training model to improve trainees' self-confidence as well as their performance in terms of knowledge, clinical reasoning and skills. High-fidelity simulation is highly recommended and ought to be included in the critical care training of residents regularly.

1. 楊惠文、陳品糖、陳隆景(2006)。以病人模擬器進行急重症醫療處置訓練。醫學教育，10，126-134。
   連結：
2. Baker GR,Norton PG,Flintoft V(2004).The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada.CMAJ,170,1678-1686.
3. Bloom BS(1956).Handbook I: The cognitive domain.New York:David McKay Co Inc..
4. Boulet JR,Murray D,Kras J(2003).Reliability and validity of a simulation-based acute care skills assessment for medical students and residents.Anesthesiology,99,1270-1280.
5. Brennan TA,Leape LL,Laird NM(1991).Incidence of adverse events and negligence in hospitalized patients.Results of the Harvard Medical Practice Study I. N Engl J Med,324,370-376.
6. Chopra V,Gesink BJ,De Jong J(1994).Does training on an anaesthesia simulator lead to improvement in performance?.Br J Anaesth,73,293-297.
7. Cook CJ,Smith GB(2004).Do textbooks of clinical examination contain information regarding the assessment of critically ill patients?.Resuscitation,60,129-136.
8. Dorman T,Angood PB,Angus DC(2004).Guidelines for critical care medicine training and continuing medical education.Crit Care Med,32,263-272.
9. Gaba DM,Howard SK,Flanagan B(1998).Assessment of clinical performance during simulated crises using both technical and behavioral ratings.Anesthesiology,89,8-18.
10. Gilbart MK,Hutchison CR,Cusimano MD(2000).A computer-based trauma simulator for teaching trauma management skills.Am J Surg,179,223-228.
11. Good ML(2003).Patient simulation for training basic and advanced clinical skills.Med Educ,37(1),14-21.
12. Gordon JA,Wilkerson WM,Shaffer DW(2001)."Practicing" medicine without risk: students΄ and educators΄ responses to high-fidelity patient simulation.Acad Med,76,469-472.
13. Grenvik A,Schaefer JJ,3rd, DeVita MA(2004).New aspects on critical care medicine training.Curr Opin Crit Care,10,233-237.
14. Holcomb JB,Dumire RD,Crommett JW(2002).Evaluation of trauma team performance using an advanced human patient simulator for resuscitation training.J Trauma,52,1078-1085.
15. Holmboe ES(2004).Faculty and the observation of trainees΄ clinical skills: problems and opportunities.Acad Med,79,16-22.
16. Howley LD(2004).Performance assessment in medical education: where we΄ve been and where we΄re going.Eval Health Prof,27,285-303.
17. Kneebone R(2005).Evaluating clinical simulations for learning procedural skills: a theory-based approach.Acad Med,80,549-553.
18. Kneebone RL,Scott W,Darzi A(2004).Simulation and clinical practice: strengthening the relationship.Med Educ,38,1095-1102.
19. Kohn KT CJ,Donaldson MS (editors)(1999).To err is human: building a safer health system.Washington DC:Committee on Quality of Health Care In America. Institute of Medicine, National Academy Press.
20. Marshall RL,Smith JS,Gorman PJ(2001).Use of a human patient simulator in the development of resident trauma management skills.J Trauma,51,17-21.
21. Norcini JJ(2003).ABC of learning and teaching in medicine: work based assessment.BMJ,326,753-755.
22. O''Brien G,Haughton A,Flanagan B(2001).Interns΄ perceptions of performance and confidence in participating in and managing simulated and real cardiac arrest situations.Med Teach,23,389-395.
23. Perkins G,Barrett H,Bullock I(2005).The Acute Care Undergraduate Teaching (ACUTE) Initiative: consensus development of core competencies in acute care for undergraduates in the United Kingdom.Intensive Care Med,31,1627-1633.
24. Rogers PL,Jacob H,Rashwan AS(2001).Quantifying learning in medical students during a critical care medicine elective: a comparison of three evaluation instruments.Crit Care Med,29,1268-1273.
25. Savoldelli GL,Naik VN,Park J(2006).Value of debriefing during simulated crisis management: oral versus video-assisted oral feedback.Anesthesiology,105,279-285.
26. Schull MJ,Ferris LE,Tu JV(2001).Problems for clinical judgement: 3. Thinking clearly in an emergency.CMAJ,164,1170-1175.
27. Vozenilek J,Huff JS,Reznek M(2004).See one, do one, teach one: advanced technology in medical education.Acad Emerg Med,11,1149-1154.
28. Wong N(2005).Medical education in critical care.J Crit Care,20,270-273.
29. 陳祖裕(2005)。「應用模擬人於臨床技能教育之推廣計畫」研究成果報告。

1. 高毓秀、李玉珊(2016)。護理人員參與擬真情境放射線治療皮膚照護工作坊之學習成效研究。護理雜誌，63(4)，80-89。
2. 謝素英,許麗齡,翁瑞萱(2018)。情境案例運用於內外科護理癌症單元之學習滿意度研究。腫瘤護理雜誌，18(1)，45-59。
3. 薛敦品,蔡淳娟,蔡金川,洪裕強(2023)。中醫內科臨床技能情境模擬測驗初探。中醫內科醫學雜誌，21(2)，1-10。
4. 鄭嘉惠、郭書麟、洪聖惠、卓淑玲、王晨旭、王拔群(2013)。以醫療異常事件發展高擬真團隊訓練模擬課程。醫務管理期刊，14(3)，183-195。
5. 鍾國彪、董鈺琪、洪聖惠、李惠珍、吳永隆、王拔群(2017)。高擬真團隊模擬訓練對安全態度、行為及病人安全文化影響之探討。醫務管理期刊，18(2)，89-104。