以病人模擬器及標準化病人進行針對日常例行醫療個案之跨領域團隊合作調練

Using Human Patient Simulators and Standardized Patients in Interdisciplinary Teamwork Training for Clinical Daily Practice

10.6145/jme.201009_14(3).0005

黃金洲(Chin-Chou Huang)；黃加璋(Chia-Chang Huang)；梁仁峰(Jen-Feng Liang)；黃鈴茹(Ling-Ju Huang)；程雅琳(Ya-Lin Chen)；林幸榮(Shing-Jong Lin)；陳肇文(Jaw-Wen Chen)

例行醫療 ； 危機資源管理 ； 模擬 ； 團隊合作 ； clinical daily practice ； crisis resource management ； simulation ； teamwork

Journal of Medical Education

14卷3期（2010 / 09 / 01）

202 - 221

繁體中文

背景：良好的團隊合作是成功施行臨床醫療的基礎。團隊合作訓練最早起源於航空業，之後被應用在麻醉、急診及重症醫學等跨領域的臨床醫療上，一般內容包括上課、討論、及演練。本研究的目地，是希望能為日常例行醫療建立一套新的結合病人模擬器和標準化病人的跨領域團隊合作訓練課程。研究方法：自2010年4月起，我們開始針對日常例行醫療個案舉辦一系列的跨領域團隊合作訓練課程，內容包括醫學模擬操作、回饋和討論，將病人模擬器和標準化病人結合應用在課程之中；參加對象包括醫師、護理師、藥師、放射師、檢驗師及呼吸治療師等職系的老師和學員。在每次的課程結束之後，所有的參與者都需填寫評估問春。結果：總共51位參與者參加本訓練課程，問春的回收率達到100%。有47位(92.1%)參與者對課程感到滿意；教師和學生對課程的整體滿意度相近(P=0.437)，但教師認為此課程可幫助了解團隊合作重要性的滿意度高於學生(P=0.027)，教師對於學生在演練中表現的滿意度也高於學生自己的滿意度(P=0.002)；在不同職系間的整體滿意度並無差異（P=0.287）。結論：病人模擬器和標準化病人可成功的應用於日常例行醫療個案之跨領域團隊合作訓練課程。這是一種新的教學訓練模式，值得推廣。

Background: Teamwork and communication contribute to successful clinical medical practice. Training in teamwork and communication, including teaching lectures; discussion and practice, has been adapted to interdisciplinary teamwork associated with anesthesia; emergency departments, and intensive care units. The aim of this study was to develop a new course of interdisciplinary teamwork training using human patient simulators and standardized patients when training for clinical daily practice. Methods: In April 2010; we started a series of interdisciplinary teamwork training courses at a single medical center. The contents of the training included medical simulations, feedback; and discussion. Both human patient simulators and standardized patients were used in the simulations. The participants included doctors, nurses; pharmacists; medical technologists; medical imagists; and respiratory therapists. Both teachers and students joined the course. After training, all the participants were asked to complete a questionnaire that included questions using Likert scales and short written assessments. Results: A total of 51 participants joined the training course. The response rate for the questionnaire was 100%. Overall; most of the participants (47 participants, 92.1%) were satisfied with the course. When the satisfaction levels of the teachers and students were compared; they were similar (p=0.437). However, the teachers’ satisfaction in terms of knowing the importance of teamwork was higher than that of the students (p=0.027). In addition; the teachers' satisfaction with the performance of the students was higher than of the students themselves (p=0.002). No difference in the satisfaction between physicians, nurses; pharmacists; medical technologists, medical imagists; and respiratory therapists was found (p=0.287). Conclusion: Both human patient simulators and standardized patients can be successfully applied to interdisciplinary teamwork training for clinical daily practice. Therefore, interdisciplinary teamwork training using both human patient simulators and standardized patients is a new and promising teaching model.

1. Chang, B.Y.、Shieh, J.Y.、Hsu, Y.D.(2005)。Evaluating the clinical competence of the intern。J Med Educ，9，233-240。
   連結：
2. Chang, B.Y.、Shieh, J.Y.、Wang, J.O.(2007)。Evaluating the clinical competence of emergency medicine interns using standardized patients。J Med Educ，11，27-38。
   連結：
3. Shieh, J.Y.、Chang, B.Y.、Kao, S.Y.(2004)。Standardized patient and medical education。J Med Educ，8，243-254。
   連結：
4. Tsai, S.L.、Yang, C.W.、Yeh, C.C.(2007)。The recruitment and training of standardized patients at National Taiwan University Hospital。J Med Educ，11，174-181。
   連結：
5. Tsai, T.C.、Lin, C.H.、Chen, C.L.(2006)。Analysis of OSCE results: Experience in national Cheng Kung University Medical College。J Med Educ，10，313-323。
   連結：
6. Yang, H.W.、Chen, P.T.、Chen, L.K.(2006)。Management of Critically Ill Patients: A Training Program Using Human Patient Simulators。J Med Educ，10，126-134。
   連結：
7. (1993).Cockpit Resource Management.San Diego:Academic Press.
8. Allan, C.K.,Thiagarajan, R.R.,Beke, D.(2010).Simulation-based training delivered directly to the pediatric cardiac intensive care unit engenders preparedness, comfort, and decreased anxiety among multidisciplinary resuscitation teams.J Thorac Cardiovasc Surg,140,646-652.
9. Baker, D.P.,Day, R.,Salas, E.(2006).Teamwork as an essential component of high-reliability organizations.Health Serv Res,41,1576-1598.
10. Barrows, H.S.(1993).An overview of the uses of standardized patients for teaching and evaluating clinical skills.Acad Med,68,443-453.
11. Barrows, H.S.(1964).Abrahamson S: The programmed patient: A technique for appraising student performance in clinical neurology.J Med Educ,39,802-805.
12. Bognár, A.,Barach, P.,Johnson, J.K.(2008).Errors and the burden of errors: Attitudes, perceptions, and the culture of safety in pediatric cardiac surgical teams.Ann Thorac Surg,85,1374-1381.
13. Brown, D.,Chronister, C.(2009).The effect of simulation learning on critical thinking and self-confidence when incorporated into an electrocardiogram nursing course.Clin Simul Nurs,5,45-52.
14. Cooper, S.,O''Carroll, J.,Jenkin, A.(2007).Collaborative practices in unscheduled emergency care: Roleand impact of the emergency care practitioner-Qualitative and summative findings.Emerg Med J,24,625-629.
15. DeVita, M.A.,Schaefer, J.,Lutz, J.(2005).Improving medical emergency team (MET) performance using a novel curriculum and a computerized human patient simulator.Qual Saf Health Care,14,326-331.
16. Dieckmann, P.,Molin, Friis S.,Lippert, A.(2009).The art and science of debriefing in simulation: Ideal and practice.Med Teach,31,e287-294.
17. Guimerà, R.,Uzzi, B.,Spiro, J.(2005).Team assembly mechanisms determine collaboration network structure and team performance.Science,308,697-702.
18. Hicks, C.M.,Bandiera, G.W.,Denny, C.J.(2008).Building a simulation-based crisis resource management course for emergency medicine, phase 1: Results from an interdisciplinary needs assessment survey.Acad Emerg Med,15,1136-1143.
19. Howard, S.K.,Gaba, D.M.,Fish, K.J.(1992).Anesthesia crisis resource management training: Teaching anesthesiologists to handle critical incidents.Aviat Space Environ Med,63,763-770.
20. Huang, Y.S.,Liu, M.,Huang, C.H.(2007).Implementation of an OSCE at Kaohsiung Medical University.Kaohsiung J Med Sci,23,161-169.
21. Lin, M.H.、Chen, C.H.、Tsai, S.T.(2000)。The assessment of 'clinical examination' teaching by Group Objective Structured Clinical Examination (GOSCE)。J Med Educ，4，454-465。
22. McIntyre, R.,Salas, E.(1995).Measuring and managing for team performance: Emerging principles from complex environments.Team Effectiveness and Decision Making in Organizations,San Francisco, CA:
23. Moorthy, K.,Munz, Y.,Adams, S.(2005).A human factors analysis of technical and team skills among surgical trainees during procedural simulations in a simulated operating theatre.Ann Surg,242,631-639.
24. Nagpal, K.,Vats, A.,Ahmed, K.(2010).A systematic quantitative assessment of risks associated with poor communication in surgical care.Arch Surg,145,582-588.
25. Reznek, M.,Smith-Coggins, R.,Howard, S.(2003).Emergency medicine crisis resource management (EMCRM): Pilot study of a simulation-based crisis management course for emergency medicine.Acad Emerg Med,10,386-389.
26. Riley, R.(ed.)(2008).Manual of simulation in healthcare.Oxford University Press.
27. Savoldelli, G.L.,Naik, V.N.,Park, J.(2006).Value of debriefing during simulated crisis management: Oral versus video-assisted oral feedback.Anesthesiology,105,279-285.
28. Schull, M.J.,Ferris, L.E.,Tu, J.V.(2001).Problems for clinical judgement: 3. Thinking clearly in an emergency.CMAJ,164,1170-1175.
29. Small, S.D.(2007).Simulation applications for human factors and systems evaluation.Anesthesiol Clin,25,237-259.
30. Thomas, E.J.,Taggart, B.,Crandell, S.(2007).Teaching teamwork during the Neonatal Resuscitation Program: A randomized trial.J Perinatol,27,409-414.
31. Ummenhofer, W.,Amsler, F.,Sutter, P.M.(2001).Team performance in the emergency room: Assessment of inter-disciplinary attitudes.Resuscitation,49,39-46.
32. Weiner, E.K.B.,Helmreich, R.(1993).Cockpit resource management.San Diego:Academic Press.
33. Whitfield, J.(2008).Collaboration: Group theory.Nature,455,720-723.
34. Wright, M.C.,Phillips-Bute, B.G.,Petrusa, E.R.(2009).Assessing teamwork in medical education and practice: Relating behavioural teamwork ratings and clinical performance.Med Teach,31,30-38.

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5. 謝雪貞,蔡秀玲,曾燕萍,張玉霞,李湘鳳(2017)。運用醫療團隊資源管理提升某復健單位護理人員急救能力。台灣專科護理師學刊，4(1)，56-66。