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Проблеми екологц та медицини
ного профтю», «Пропедевтика внутрiшньоí медицини», «Внутршня медицина».
Студенти II курсу в фантомному клас «Догляд за хворими» освоюють технiку манiпупяцiй з догляду за хворими. Згщно програми дисциплЫи студенти пови-ннi засвоíти 28 практичних навичок, на кожну з яких складений iпюстрований алгоритм дм. На першому етапi викладач роз'яснюе суть манiпупяцií та показуе етапи и виконання. На другому - студент виконуе ма-нiпупяцiю пщ контролем викладача, на третьому -самостшно. В фантомному кпасi проводиться не тть-ки аудиторна робота, але й самостмна робота студе-нтiв, пiд час яко!' е можливють вiдпрацьовувати своí дií до автоматизму. Ттьки пiспя оцiнки викладачем дiй на фантомi студент допускаеться до практично1 роботи у вщдтеннк
При вивченнi «Пропедевтики внутрiшньоí медицини» та «Внутршньо1 медицини» широко використову-еться «Майстер-клас з опанування фiзикальними методами обстеження хворого», оснащений манекенами для аускультацп та пальпацп, стетоскопами, прила-дами для вимiрювання тиску та комп'ютерами з про-грамним забезпеченням.
Програма дае можливють теоретично1 подготовки з обстеження дихально1, серцево-судинно1 систем та органiв черевноí порожнини, а також проведення аускультацп легень, серця та виконання пальпацп оргаыв черевно1 порожнини. Студенти мають можливють ознайомитися як з нормальними звуковими феноменами, так i - патолопчними (вислухати додатковi ди-хапьнi шуми, патопогiчний ритм дихання, аускульта-тивну картину при рiзних захворюваннях дихапьноí системи, змiни тошв серця, серцевi та позасерцевi шуми, порушення ритму, аускультативну картину при рiзних захворюваннях серця тощо). При пальпацп ор-ганiв черевноí порожнини можна визначити положен-ня нижнього краю печЫки, нижнього полюсу селезшки та нирок.
За спостереженням викпадачiв, студенти пюля на-вчання в «Майстер-кпасi з опанування фiзикальними методами обстеження хворого» бтьш активно пра-
цюють на практичних заняттях, мають вищий piBeHb теоретично! та практично! пiдготовки.
При опитуванн студентiв, бiльшiсть з них в^^чае, що навчання в фантомному клас посилило бажання ви-вчати внутршню медицину, допомогло !м вщчути себе бiльш впевнено при робот з реальними пацiентами.
Таким чином, застосування фатгшв та манекенiв у навчанн студентiв стоматологiчного факультету приводить до хорошого рiвня засвоення теоретично! частини i оволодiння практичними навичкам, яга необ-хiднi в робот кожному молодому спецiалiсту.
Лiтература:
1. Горшков М.Д., Колыш А.Л. История симуляционного обучения в России и за рубежом: материалы 1 съезда РОСОМЕД - 2012. Москва, 27 - 28 сентября 2012г.
2. Досмагамбетова Р.С. Рекомендации по внедрению обучения на основе симуляционных технологий в учебный процесс медицинского вуза /Р.С. Досмагамбетова, А.С. Кусаинова, В.П. Риклефс //Медицинское образование и профессиональное развитие - 2011 - №3.
3. Муравьев К.А., Ходжаян А.Б., Рой С.В. Симуляционное обучение в медицинском образовании - переломный момент. //Фундаментальные исследования. - 2011. -№ 10-3. - С. 534-537.
4. Мурин С. Использование симуляторов в обучении: переломный момент /С. Мурин, Н. С. Столленверк //Виртуальные технологии в медицине: науч.-практич. журн. - 2010. - № 1 (5). - С. 7-10.
5. Низовибатько О.Б. Медицинские сиулятивные центры - перспектива практического здравоохранения. Вестник ТГУ, т.8, вып.1, 2013, . 311-312.
6. Хомазюк Т.А. Досвщ оптимiзацi! мотивацп Ыоземних студенев до вивчення внутршых хвороб /Т.А. Хомазюк, С.Й.Крижаывська, К.Ю.бгоров, Ю.П.Артамонов, О.1.Кравченко// Медична освп-а - 2002 - №3 - с.209 - 211.
7. Clinical simulation importance to the internal medicine educational mission /P. E. Ogden, L. S. Cobbs, M. R. Howell, S. J. Sibbitt, D. J. Di - Pette //Am J Med. -2007. - № 120 (9). - Р. 820 - 824.
8. National Growth in Simulation Training within Emergency Medicine Residency Programs / Y. Okuda et al. //Acad. Em. Med. - 2008. - № 15. - Р. 1-4.
9. The effect of hi-fisimulation on educational outcomes /D. L. Rodgers et. at. //Simulation in Healthcare. - 2009. -№ 4. - Р. 200 - 206.
ENGLISH VERSION: APPLICATION OF SIMULATION METHODS OF TEACHING INTERNAL MEDICINE TO STUDENTS OF DENTAL FACULTIES*
S.Y. Kryzhanivska, V.I. Hrytsenko, T.L. Simonova
SE "Dnipropetrovsk Medical Academy of the Ministry of Public Health of Ukraine", Dnepropetrovsk, Ukraine
The study of internal medicine by students of dental faculty has a number of difficulties: concentration of students' effort and time to study core subjects, failure in (sometimes - absence of) understanding the importance of individual therapy in the practice of dentist and limited number of hours to study the subject. It has been shown that one of the variants of their solution is the use of phantoms and mannequins in training students of dental faculties
Keywords: simulative training methods, internal medicine, dental faculties, phantoms, mannequins
The success of a future dentist essentially depends not only on the professional knowledge of the specialty, but also on general medical training. In this regard, a program of internal medicine for students specialized in
"Dentistry" at higher medical educational institutions, should be considered as a basic clinical discipline [1, 2, 4].
However, the study of internal medicine by students of dental faculty has a number of difficulties: concentra-
* To cite this English version: S.Y. Kryzhanivska, V.I. Hrytsenko, T.L. Simonova. Application of simulation methods of teaching internal medicine to students of dental faculties //Problemy ekologii ta medytsyny. - 2015. - Vol 19, № 5-6. - P. 27-28.
Tom 19. N 5-6 2015 p.
tion of students' effort and time to study core subjects, failure in (sometimes - absence of) understanding the importance of individual therapy in the practice of dentist and limited number of hours to study the subject. In addition, future dentists have a "psychological barrier" in dealing with patients, lack of confidence in their ability to conduct examination, to assess the patient and correct results, perform routine medical procedures [6].
Certainly, training a qualified physician is impossible without contact with real patients. As is known, most of the conflicts in health care arise due to low level of health workers practical skills and ethical basics of communication with patients. However, in the training of future doctors one should take into account not only the interests of students, but also those of patients [2, 6].
At present, according to recommendations of the World Alliance for Patient Safety with the support of WHO "Guidelines for the safety of patients to medical institutions" (WHO, 2009) were published, stating that medical schools should provide a safe learning environment for teaching clinical manipulations [2, 9].
One way of achieving this is phantom-simulation training. Simulators have been known in the world since the eighteenth century after the invention of birth phantom by Madame du Coudray. But the greatest development stimulation technology has gained in the twentieth century. Hence, Peter Safar developed the principles of cardiopulmonary resuscitation and persuaded Norwegian manufacturer of rubber toys Asmunda Laerdala to make a mannequin Resaski Anne, who was the "most kissed girl of all time." Gordon Michael Harvey created a mannequin for training examination of the cardiovascular and respiratory systems. At Stanford University under supervision of David Gaba anesthetical patient simulant CASE was created (1986). With its help in 1992 in cooperation with Harvard School of Medicine the so-called "Great stimulation experiment" was conducted which convincingly proved the effectiveness of learning through simulation technologies [5].
According to recommendations of R.Harden, one can distinguish 6 levels of practical skills development:
Level 1. Theoretical introduction.
Level 2. Complete theoretical understanding.
Level 3. Observation of implementation.
Level 4. Implementation on a mannequin.
Level 5. Performance under supervision.
Level 6. Independent implementation.
In mannequin class, practical skills are mastering up to the Level 4 [2].
The mastery of clinical skills using mannequins, trainers and promoters under the teacher's supervision allows students to make mistakes in a "safe environment" that improves their learning practical procedures. Phantoms and stimulants can bring the performance skills to automatism through frequent repetition of the same acts, which in turn leads to a decrease in errors in the actual medical practice [2,3,7,8].
On the basis of our department, we conduct training students of Dental Faculty, II-IV years of study on the following subjects: "Nursing therapeutic profile", "Propaedeutics to Internal Medicine", "Internal medicine".
In the phantom class "Nursing" students of the second year of study master the technique of manipulating care. According to the program of the course, students should learn 28 practical skills, each of which is provided by illustrated sequence of actions. In the first phase the teacher explains the essence of manipulation and shows the stages of its implementation. At the second a student performs manipulation under teacher's control; at the third - alone. In phantom class not only classroom work
is held, but independent work of students is accomplished as well, during which there is the opportunity to work out their actions to automatism. Only after teacher's assessing of acts on a phantom, the student is admitted to the practice at the department.
In the study of "Propedeutics to Internal Medicine" and "Internal medicine" "Workshop on mastering the methods of physical examination of the patient" is widely used, equipped with a mannequin for auscultation and palpation, stethoscope, blood pressure monitor and a computer with software.
The program enables theoretical training in examination of the respiratory and cardiovascular systems and the abdomen, auscultation of the lungs, heart and palpation of the abdomen. Students have the opportunity to see both normal and pathological sound phenomena (listen to additional respiratory noises, abnormal respiratory rate, auscultation picture in various diseases of the respiratory system, changing heart tones, heart and extracar-diac noise arrhythmias, auscultation picture in various diseases of the heart, etc). At palpation of the abdomen one can determine the position of the lower edge of the liver, lower pole of the spleen and kidneys.
After working at "Workshop on mastering the methods of physical examination of the patient" under teacher's supervision students are more active, they have higher level of theoretical and practical training.
In a survey of students, most of them remark that studies in the phantom classroom strengthened their desire to study internal medicine, helped them to feel more confident when working with real patients.
Thus, the use of phantoms and mannequins in training students of dental faculties leads to a good level of mastering the theoretical and practical skills necessary in the work of every young specialist.
References:
1. Gorshkov M.D., Kolysh A.L. Istoriya simulyatsionnogo obucheniya v Rossii i za rubezhom: materialy 1 s"yezda ROSOMED - 2012. Moskva, 27 - 28 sentyabrya 2012g.
2. Dosmagambetova R.S. Rekomendatsii po vnedreniyu obucheniya na osnove simulyatsionnykh tekhnologiy v uchebnyy protsess meditsinskogo vuza /R.S. Dosmagambetova, A.S. Kusainova, V.P. Riklefs //Meditsinskoye obrazovaniye i professional'noye razvitiye - 2011 - №3.
3. Murav'yev K.A., Khodzhayan A.B., Roy S.V. Simulyatsion-noye obucheniye v meditsinskom obrazovanii - perelom-nyy moment. //Fundamental'nyye issledovaniya. - 2011. -№ 10-3. - S. 534-537.
4. Murin S. Ispol'zovaniye simulyatorov v obuchenii: pere-lomnyy moment /S. Murin, N. S. Stollenverk //Virtual'nyye tekhnologii v meditsine: nauch.-praktich. zhurn. - 2010. -№ 1 (5). - S. 7-10.
5. Nizovibat'ko O.B. Meditsinskiye siulyativnyye tsentry -perspektiva prakticheskogo zdravookhraneniya. Vestnik TGU, t.8, vyp.1, 2013, . 311-312.
6. Khomazyuk T.A. Dosvid optymizatsiyi motyvatsiyi inozem-nykh studentiv do vyvchennya vnutrishnikh khvorob /T.A. Khomazyuk, S.Y.Kryzhanivsnka, K.YU.Yehorov, YU.P.Artamonov, O.I.Kravchenko// Medychna osvita -2002 - №3 - s.209 - 211.
7. Clinical simulation importance to the internal medicine educational mission /P. E. Ogden, L. S. Cobbs, M. R. Howell, S. J. Sibbitt, D. J. Di - Pette //Am J Med. -2007. - № 120 (9). - P. 820 - 824.
8. National Growth in Simulation Training within Emergency Medicine Residency Programs / Y. Okuda et al. //Acad. Em. Med. - 2008. - № 15. - P. 1-4.
9. The effect of hi-fisimulation on educational outcomes /D. L. Rodgers et. at. //Simulation in Healthcare. 2009. -№ 4. - P. 200 - 206.
