近年来,以语言描述、图片展示、临床见习为主的传统医学教育模式越来越不能满足现代医学教育的多样化需求。而不断发展的三维(three dimension,3D)打印、3D虚拟模型及增强现实(augmented reality,AR)和混合现实(mixed reality,MR)技术,在医学教育方面逐渐显露出独特优势。以上技术具有立体性、真实性、交互性等特点,可以充分还原人体解剖结构、生理病理变化和手术操作过程,从而提高了教学质量,激发了学生的学习兴趣。本文以3D打印、3D虚拟模型及AR和MR技术作为计算机三维可视化技术的代表,对医学教育的应用价值进行了研究和总结,并结合本团队对于相关技术的学习和应用经验,对以上技术在医学教育中的应用价值做出展望。
In recent years, the traditional medical education pedagogy methodology, which is mainly based on trainers’ description, picture demonstration and clinical novitiate, fails to meet the diversified demand of medical education. The evolving three dimension(3D) printing, 3D model, augmented reality(AR) and mixed reality(MR) technologies gradually demonstrated unique advantages in medical education. The technology is stereoscopic, authentic and interactive, which effectively shows authentic anatomical architecture, physiological and pathological changes as well as surgical procedure, improving teaching quality and stimulating the interest of learning. Combining our experience in learning and applications of related technologies, this article summarized the application value in medical education of 3D printing, 3D model, AR and MR as representatives of computed three-dimensional visualization technology, and made a prospect for the value of the technology in medical education.
[1] 徐孟超. 浅谈国内外三维可视化发展及其应用[J]. 现代测绘, 2012,35(6):60-62.DOI: 10.3969/j.issn.1672-4097.2012.06.022.
[2] 丁晶, 曾超美. 虚拟现实技术在临床医学教育中的应用及思考[J]. 中国高等医学教育, 2019(7):27-28. DOI:10.3969/j.issn.1002-1701.2019.07.014.
[3] Rengier F, Mehndiratta A, von Tengg-Kobligk H, et al. 3D printing based on imaging data: review of medical applications[J].Int J Comput Assist Radiol Surg,2010,5(4):335-341.DOI:10.1007/s11548-010-0476-x.
[4] 王鸣, 罗滨林. 3D打印技术在临床医学教育的应用[J]. 管理观察, 2017(29):173-174.DOI:10.3969/j.issn.1674-2877.2017.29.071.
[5] 李新宇, 朱继业, 黄磊, 等. 三维打印技术在肝胆外科学教学中的应用及效果评估[J]. 中华医学教育杂志, 2017,37(5):708-712.DOI:10.3760/cma.j.issn.1673-677X.2017.05.016.
[6] 郑佳平, 陈国强, 李储忠. 3D打印微血管减压手术训练模型的制作与评价[J]. 中国医学装备, 2018,15(12):61-65. DOI:10.3969/J.ISSN.1672-8270.2018.12.015.
[7] 朱俊豪, 文国道, 丛子翔, 等. 应用3D打印颅脑模型行内镜下经鼻蝶入路手术训练[J]. 中国微侵袭神经外科杂志, 2018,23(11):527-528. DOI:10.11850/j.issn.1009-122X.2018.11.015.
[8] 刘小兵, 吴天鹏, 祝存海, 等. 3D打印技术在腹腔镜超选择性阻断保留肾单位手术中的应用[J]. 武汉大学学报(医学版), 2019,40(6):936-941.DOI:10.14188/j.1671-8852.2018.0918.
[9] 赵波, 刘颖, 邱晓文, 等. 3D打印技术在脊柱外科手术教学和训练中的应用[J]. 中国医学教育技术, 2015,29(5):547-549.DOI:10.13566/j.cnki.cmet.cn61-1317/g4.201505021.
[10]侯鹏高. 虚拟人体研究进展[J]. 齐齐哈尔医学院学报, 2013,34(15):2280-2281.
[11]Jamil Z, Saeed AA, Madhani S, et al. Three-dimensional visualization software assists learning in students with diverse spatial intelligence in medical education[J]. Anatomical Sciences Education, 2019,12(5):550-560.DOI: 10.1002/ase.1828.
[12]罗贤臣, 尚成浩, 潘晶雪, 等. 多媒体3D课件在神经系统解剖学中的应用与研究[J]. 医学理论与实践, 2017,30(19):2962-2963.DOI:10.19381/j.issn.1001-7585.2017.19.085.
[13]龚文锋, 林有智, 陈祖舜, 等. 虚拟三维数字化肝脏制作及其在临床外科教学中的应用[J]. 右江民族医学院学报, 2016,38(6):635-637.DOI:10.3969/j.issn.1001-5817.2016.06.028.
[14]王兴国, 郝廷, 王建忠, 等. 三维数字化重建及打印技术在骨科临床教学中的应用[J]. 中华医学教育探索杂志,2019,18(8):834-838. DOI:10.3760/cma.j.issn.2095-1485.2019.08. 019.
[15]Loke Y, Harahsheh A, Krieger A, et al. Usage of 3D models of tetralogy of Fallot for medical education: impact on learning congenital heart disease[J]. BMC Medical Education, 2017,17(1):54. DOI:10.1186/s12909-017-0889-0.
[16]陈沛, 郜鑫磊, 汪铭. 生理学三维动画的制作技巧及体会[J]. 中国医学教育技术, 2016,30(2):156-158. DOI:10.13566/j.cnki.cmet.cn61-1317/g4.201602012.
[17]林乐迎, 欧阳娟. 麻醉解剖教学中3D臂丛解剖动画的运用[J].才智, 2015(29):206.
[18]牛兆河, 张磊, 王海波. 标准化患者结合乳腺三维模型动画教学法在乳腺外科临床实习教学中的应用探讨[J]. 中国医学教育技术, 2015,29(3):291-294.DOI:10.13566/j.cnki.cmet.cn61-1317/g4.201503015.
[19]Herron J. Augmented reality in medical education and training[J].Journal of Electronic Resources in Medical Libraries,2016,13(2):51-55.DOI:10.1080/15424065.2016.1175987.
[20]Loidl M, Schneider A, Keis O, et al. Augmented reality in ophthalmology: technical innovation complements education for medical students[J]. Klin Monbl Augenheilkd, 2020,237(5):689-698. DOI:10.1055/a-0767-7063.
[21]Ferrer-Torregrosa J, Jimenez-Rodriguez A, Torralba-Estelles J, et al. Distance learning ects and flipped classroom in the anatomy learning: comparative study of the use of augmented reality, video and notes[J]. BMC Med Educ, 2016,16(1):230. DOI:10.1186/s12909-016-0757-3.
[22]Kornbau C, Lee KC, Hughes GD, et al. Central line complications[J]. Int J Crit Illn Inj Sci, 2015, 5(3):170-178.
[23]Barsuk JH, Cohen ER, Mikolajczak A, et al. Simulation-based mastery learning improves central line maintenance skills of ICU nurses[J]. J Nurs Adm, 2015,45(10):511-517. DOI:10.1097/NNA.0000000000000243.
[24]Izard SG, Juanes JA, Garcia PF, et al. Virtual reality as an educational and training tool for medicine[J]. J Med Syst, 2018,42(3):50-54. DOI:10.1007/s10916-018-0900-2.
[25]曾宁, 范应方, 杨剑, 等. 数字虚拟技术在肝胆外科临床教学中的应用研究[J]. 中国继续医学教育, 2018,10(33):16-19. DOI:10.3969/j.issn.1674-9308.2018.33.007.
[26]刘金鑫, 靳泽宇, 李雯雯, 等. 5G远程医疗的探索与实践[J]. 电信工程技术与标准化, 2019,32(6):83-86. DOI:10.13992/j.cnki.tetas.2019.06.017.
[27]Huang TK, Yang CH, Hsieh YH, et al. Augmented reality (AR) and virtual reality (VR) applied in dentistry[J]. Kaohsiung J Med Sci, 2018,34(4):243-248. DOI:10.1016/j.kjms.2018.01.009.
[28]Mahmood F, Mahmood E, Dorfman RG, et al. Augmented reality and ultrasound education: initial experience[J]. J Cardiothorac Vasc Anesth, 2018,32(3):1363-1367. DOI:10.1053/j.jvca.2017.12.006.