超声引导下的神经阻滞麻醉(ultrasound-guided regional anesthesia, UGRA)是麻醉科住院医师规范化培训的重要内容,但存在着学员眼手协调能力弱、相关解剖结构不易掌握、缺乏学习兴趣等问题,目前尚无相关标准课程。北京大学人民医院麻醉科分析UGRA教学特点,总结出发挥模拟教学优势、开展游戏化教学、指导学员进行刻意练习等教学对策,取得了较好的教学效果。
Ultrasound-guided regional anesthesia (UGRA) skills should be well-mastered in standardized resident training. The operation of UGRA is difficult to master and with high standards. There is no standardized course for UGRA at present. There are some weaknesses in UGRA teaching, such as poor coordination between eyes and hands, difficulty in mastering related anatomical structures and lack of interest in learning. This paper analyzed the characteristics of UGRA teaching in the Department of Anesthesiology, Peking University People's Hospital, and summarized the corresponding teaching strategies, such as extensive application of simulation technology in training process and strengthening of training on deliberate practice. These measures had achieved good outcomes.
[1] 王玉洁, 徐懋, 李民, 等. 住院医师两种股神经阻滞麻醉教学学习曲线的比较[J].中华医学教育杂志,2019,39(12):946-949. DOI: 10.3760/cma.j.issn.1673-677X.2019.12.013.
[2] Orebaugh SL, Williams BA, Vallejo M, et al. Adverse outcomes associated with stimulator-based peripheral nerve blocks with versus without ultrasound visualization[J]. Reg Anesth Pain Med, 2009, 34(3):251-255. DOI: 10.1097/AAP.0b013e3181a3438e.
[3] Forouzan A, Masoumi K, Motamed H, et al. Nerve Stimulator versus ultrasound-guided femoral nerve block: A randomized clinical trial[J]. Emerg (Tehran), 2017, 5(1):e54.
[4] Nix CM, Margarido CB, Awad IT, et al. A scoping review of the evidence for teaching ultrasound-guided regional anesthesia[J]. Reg Anesth Pain Med, 2013, 38(6):471-480. DOI: 10.1097/AAP.0b013e3182a4ed7a.
[5] Yunoki K, Sakai T. The role of simulation training in anesthesiology resident education[J]. J Anesth, 2018, 32(3):425-433. DOI: 10.1007/s00540-018-2483-y.
[6] 卢伟忠. 绘图比赛对多媒体教学背景下的解剖学教学的促进作用[J].广东职业技术教育与研究,2019(3):105-107. DOI: 10.3969/j.issn.1672-2744.2019.03.036.
[7] Shafqat A, Ferguson E, Thanawala V, et al. Visuospatial ability as a predictor of novice performance in ultrasound-guided regional anesthesia[J]. Anesthesiology, 2015, 123(5):1188-1197. DOI: 10.1097/ALN.0000000000000870.
[8] 冯越, 冯萌鸽, 王珏. 微课教学应用模式(五)——输出式学习[J].中国信息技术教育,2019(15):125-128. DOI: 10.3969/j.issn.1674-2117.2019.15.043.
[9] 程浩, 陆伟萍, 高献忠, 等. 不同模拟穿刺模型在超声引导穿刺技术教学中的比较研究[J].临床超声医学杂志,2019,21(7):552-554. DOI: 10.3969/j.issn.1008-6978.2019.07.026.
[10] Kessler J, Moriggl B, Grau T. Ultrasound-guided regional anesthesia: learning with an optimized cadaver model[J]. Surg Radiol Anat, 2014, 36(4):383-392. DOI: 10.1007/s00276-013-1188-z.
[11] Naraghi L, Lin J, Odashima K, et al. Ultrasound-guided regional anesthesia simulation: use of meat glue in inexpensive and realistic nerve block models[J]. BMC Med Educ, 2019, 19(1):145. DOI: 10.1186/s12909-019-1591-1.
[12] 娄绘芳, 刘怿君. “游戏化”教学在医学院校教学中的应用[J].中华医学教育杂志,2017,37(5):680-682,695. DOI: 10.3760/cma.j.issn.1673-677X.2017.05.009.
[13] Kerfoot BP, Kissane N. The use of gamification to boost residents' engagement in simulation training[J]. JAMA Surg, 2014, 149(11):1208-1209. DOI: 10.1001/jamasurg.2014.1779.
[14] Offiah G, Ekpotu LP, Murphy S, et al. Evaluation of medical student retention of clinical skills following simulation training[J]. BMC Med Educ, 2019, 19(1):263. DOI: 10.1186/s12909-019-1663-2.
[15] Ericsson KA. Deliberate practice and the acquisition and maintenance of expert performance in medicine and related domains[J]. Acad Med, 2004, 79(10 Suppl):S70-S81. DOI: 10.1097/00001888-200410001-00022.
[16] Kim TE, BCH T. Simulation-based ultrasound-guided regional anesthesia curriculum for anesthesiology residents[J]. Korean J Anesthesiol, 2019, 72(1):13-23. DOI: 10.4097/kja.d.18.00317.
[17] 崔德荣, 王晓峰, 张宇, 等. 标准化超声解剖图谱在麻醉超声可视化教学实践中的应用[J].现代医药卫生,2017,33(20):3186-3188. DOI: 10.3969/j.issn.1009-5519.2017.20.048.
[18] Turbitt LR, Mariano ER, El-Boghdadly K. Future directions in regional anaesthesia: not just for the cognoscenti[J]. Anaesthesia, 2020, 75(3):293-297. DOI: 10.1111/anae.14768.