Ukuhlukaniswa kwe-cadaver yendabuko kuya ngokuya kuncipha, kuyilapho amamodeli e-plastination kanye ne-3D ephrintiwe (3DP) athola ukuduma njengenye indlela yezindlela zokufundisa ze-anatomy zendabuko.Akukacaci ukuthi ayini amandla nobuthakathaka balawa mathuluzi amasha nokuthi angathinta kanjani umuzwa wokufunda we-anatomy wabafundi, ohlanganisa izimiso zobuntu ezifana nenhlonipho, ukunakekela, nozwela.
Ngokushesha ngemva kocwaningo lokuphambana okungahleliwe, kwamenywa abafundi abangama-96.Idizayini ye-pragmatic yasetshenziswa ukuhlola okuhlangenwe nakho kokufunda kusetshenziswa amamodeli enhliziyo enziwe ngepulasitiki ne-3D (Isigaba 1, n=63) nentamo (Isigaba 2, n=33).Ukuhlaziywa kwe-thematic inductive kwenziwa ngokusekelwe ekubuyekezweni kombhalo wamahhala okungu-278 (kubhekiselwa kumandla, ubuthakathaka, izindawo okufanele zithuthukiswe) kanye nemibhalo yezwi nezwi yamaqembu okugxilwe kuwo (n = 8) mayelana nokufunda i-anatomy kusetshenziswa lawa mathuluzi.
Kwahlonzwa izindikimba ezine: ubuqiniso obubonwayo, ukuqonda okuyisisekelo nobunkimbinkimbi, izimo zengqondo zenhlonipho nokunakekela, ukuhlukahluka, kanye nobuholi.
Ngokuvamile, abafundi babe nomuzwa wokuthi izibonelo eziphothiwe zazingokoqobo kakhulu ngakho-ke bazizwa behlonishwa futhi benakekelwa kakhulu kunamamodeli e-3DP, okwakulula ukuwasebenzisa futhi afaneleka kangcono ukufunda i-anatomy eyisisekelo.
Ukuhlolwa kwesidumbu somuntu bekuyindlela yokufundisa ejwayelekile esetshenziswa emfundweni yezokwelapha kusukela ngekhulu le-17 [1, 2].Kodwa-ke, ngenxa yokufinyelela okulinganiselwe, izindleko eziphakeme zokugcinwa kwe-cadaver [3, 4], ukunciphisa okukhulu kwesikhathi sokuqeqeshwa kwe-anatomy [1, 5], kanye nentuthuko yezobuchwepheshe [3, 6], izifundo ze-anatomy ezifundiswa kusetshenziswa izindlela zendabuko zokuhlukanisa ziyancipha. .Lokhu kuvula amathuba amasha okucwaninga izindlela ezintsha zokufundisa namathuluzi, njengezibonelo zabantu ezifakwe epulasitiki kanye namamodeli e-3D aphrintiwe (3DP) [6,7,8].
Ngalinye lalawa mathuluzi linobuhle nobubi.Izibonelo ezipuletiweyo zomile, azinaphunga, zingokoqobo futhi aziyona ingozi [9,10,11], okuzenza zilungele ukufundisa nokuheha abafundi ocwaningweni nasekuqondeni i-anatomy.Kodwa-ke, nazo ziqinile futhi aziguquki kancane [10, 12], ngakho-ke kucatshangwa ukuthi zinzima kakhulu ukuphatha nokufinyelela izakhiwo ezijulile [9].Mayelana nezindleko, amasampula epulasitiki ngokuvamile abiza kakhulu ukuthenga nokugcina amamodeli we-3DP [6,7,8].Ngakolunye uhlangothi, amamodeli e-3DP avumela ukuthungwa okuhlukile [7, 13] nemibala [6, 14] futhi angakwazi ukwabelwa izingxenye ezithile, okusiza abafundi ukuthi babone kalula, bahlukanise futhi bakhumbule izakhiwo ezibalulekile, nakuba lokhu kubonakala kungaphansi kweqiniso kune-plasticized. amasampula.
Ucwaningo oluningi luhlole imiphumela yokufunda/ukusebenza kwezinhlobo ezahlukene zamathuluzi e-anatomical njengezibonelo zepulasitiki, izithombe ze-2D, izigaba ezimanzi, amatafula e-Anatomage (Anatomage Inc., San Jose, CA) kanye namamodeli we-3DP [11, 15, 16, 17, 18, 19, 20, 21].Kodwa-ke, imiphumela yahluka ngokuya ngokukhethwa kwethuluzi lokuqeqesha elisetshenziswa emaqenjini okulawula nokungenelela, kanye nokuya ngezifunda ezahlukene ze-anatomical [14, 22].Isibonelo, uma isetshenziselwa ukuhlanganiswa ne-dissection emanzi [11, 15] kanye namathebula e-autopsy [20], abafundi babike ukwaneliseka kokufunda okuphakeme kanye nezimo zengqondo mayelana nezibonelo ezenziwe ngepulasitiki.Ngokufanayo, ukusetshenziswa kwamaphethini e-plastination kubonisa umphumela omuhle wolwazi lwenhloso yabafundi [23, 24].
Amamodeli we-3DP avame ukusetshenziselwa ukwengeza izindlela zokufundisa zendabuko [14,17,21].Loke et al.(I-2017) ibike ngokusetshenziswa kwemodeli ye-3DP ukuqonda isifo senhliziyo sokuzalwa kudokotela wezingane [18].Lolu cwaningo lubonise ukuthi iqembu le-3DP linokwaneliseka kokufunda okuphakeme, ukuqonda okungcono kwe-Fallot's tetrad, kanye nekhono elithuthukisiwe lokuphatha iziguli (ukuzimela) uma kuqhathaniswa neqembu le-imaging le-2D.Ukufunda i-anatomy yesihlahla se-vascular kanye ne-anatomy yogebhezi kusetshenziswa amamodeli we-3DP kunikeza ukwaneliseka kokufunda okufanayo njengezithombe ze-2D [16, 17].Lezi zifundo zibonise ukuthi amamodeli e-3DP aphakeme kunemifanekiso ye-2D ngokokwaneliseka kokufunda okubonwa ngumfundi.Kodwa-ke, izifundo eziqhathanisa ngokuqondile amamodeli we-3DP wezinto eziningi namasampula enziwe ngepulasitiki anomkhawulo.Mogali et al.(2021) isebenzise imodeli ye-plastination ngamamodeli ayo enhliziyo nentamo ye-3DP futhi yabika ukwanda okufanayo kolwazi phakathi kwamaqembu okulawula nawokuhlola [21].
Kodwa-ke, ubufakazi obengeziwe buyadingeka ukuze uthole ukuqonda okujulile kokuthi kungani isipiliyoni sokufunda somfundi sincike ekukhethweni kwezinsimbi ze-anatomical nezingxenye ezihlukene zomzimba nezitho [14, 22].Amanani obuntu ayingxenye ethokozisayo engathonya lo mbono.Lokhu kubhekisela ekuhlonipheni, ekunakekeleni, ekuzweleni nasekuhawukeleni okulindeleke kubafundi ababa odokotela [25, 26].Izindinganiso zobuntu bezilokhu zifunwa ekuhlolweni kwezidumbu, njengoba abafundi befundiswa ukuzwelana nokunakekela izidumbu ezinikelwe, ngakho-ke ukufunda kwe-anatomy bekulokhu kusendaweni ekhethekile [27, 28].Kodwa-ke, lokhu akuvamile ukulinganiswa ku-plasticizing kanye namathuluzi we-3DP.Ngokungafani nemibuzo yenhlolovo ye-Likert evaliwe, izindlela zokuqoqwa kwedatha ezisezingeni eliphakeme njengezingxoxo zeqembu eligxilile kanye nemibuzo yenhlolovo evulekile inikeza ukuqonda kumazwana ababambiqhaza abhalwe ngokungahleliwe ukuze achaze umthelela wamathuluzi okufunda amasha kulwazi lwabo lokufunda.
Ngakho-ke lolu cwaningo beluhlose ukuphendula ukuthi abafundi bayibona kanjani i-anatomy ngendlela ehlukile uma benikezwa amathuluzi asethiwe (i-plastination) ngokumelene nezithombe eziphrintiwe ze-3D ezibonakalayo ukuze bafunde i-anatomy?
Ukuze uphendule imibuzo engenhla, abafundi banethuba lokuzuza, ukuqongelela kanye nokwabelana ngolwazi lwe-anatomical ngokusebenzisana kweqembu nokusebenzisana.Lo mqondo uvumelana kahle nethiyori ye-constructivist, ngokusho ukuthi abantu noma amaqembu omphakathi adala futhi abelane ngolwazi lwabo [29].Ukusebenzisana okunjalo (isibonelo, phakathi kontanga, phakathi kwabafundi nothisha) kuthinta ukwaneliseka kokufunda [30, 31].Ngasikhathi sinye, isipiliyoni sokufunda sabafundi sizothonywa yizici ezinjengokufunda kalula, indawo ezungezile, izindlela zokufundisa, nokuqukethwe kwezifundo [32].Kamuva, lezi zimfanelo zingathonya ukufundwa kwabafundi kanye nokubamba kahle izihloko abazithandayo [33, 34].Lokhu kungase kuhlotshaniswe nombono wethiyori we-pragmatic epistemology, lapho isivuno sokuqala noma ukwakhiwa kokuhlangenwe nakho komuntu siqu, ukuhlakanipha, nezinkolelo kunganquma inkambo elandelayo yesenzo [35].Indlela ye-pragmatic ihlelwe ngokucophelela ukukhomba izihloko eziyinkimbinkimbi nokulandelana kwazo ngokusebenzisa izingxoxo nezinhlolovo, kulandelwa ukuhlaziywa kwe-thematic [36].
Amasampula e-Cadaver avame ukubhekwa njengabeluleki abathule, njengoba ebonwa njengezipho ezibalulekile ukuze kuzuze isayensi nobuntu, inhlonipho ekhuthazayo nokubonga okuvela kubafundi kuya kubanikeli babo [37, 38].Ucwaningo lwangaphambilini lubike amaphuzu afanayo noma aphezulu enhloso phakathi kweqembu le-cadaver/plastination kanye neqembu le-3DP [21, 39], kodwa bekungacacile ukuthi abafundi babelana ngolwazi olufanayo lokufunda, okuhlanganisa amanani obuntu, phakathi kwamaqembu amabili.Ukuze uthole olunye ucwaningo, lolu cwaningo lusebenzisa isimiso se-pragmatism [36] ukuhlola isipiliyoni sokufunda nezici zamamodeli we-3DP (umbala nokuthungwa) futhi uziqhathanise namasampuli apulasnyiwe asekelwe empendulweni yomfundi.
Imibono yabafundi ingase ibe nomthelela ezinqumweni zothisha mayelana nokukhetha amathuluzi e-anatomy afanelekile ngokusekelwe kulokho okusebenzayo nokungasebenzi kahle ekufundiseni i-anatomy.Lolu lwazi lungasiza futhi othisha ukuhlonza okuthandwa ngabafundi futhi basebenzise amathuluzi okuhlaziya afanele ukuze bathuthukise ulwazi lwabo lokufunda.
Lolu cwaningo lwekhwalithi lwaluhloselwe ukuhlola lokho abafundi abakubheka njengokubalulekile ekufundeni besebenzisa amasampula enhliziyo nentamo enziwe ngepulasitiki uma kuqhathaniswa namamodeli e-3DP.Ngokocwaningo lokuqala olwenziwe nguMogali et al.ngo-2018, abafundi babheka izibonelo ezifakwe ngopulasitiki njengezingokoqobo kakhulu kunezinhlobo ze-3DP [7].Ngakho ake sicabange ukuthi:
Njengoba kunikezwe ukuthi ama-plastinations adalwe kusuka kuma-cadaver wangempela, abafundi bekulindeleke ukuthi babuke ama-plastinations kahle kakhulu kunamamodeli we-3DP ngokobuqiniso kanye nenani lobuntu.
Lolu cwaningo lwekhwalithi luhlobene nezifundo ezimbili zangaphambilini zobuningi [21, 40] ngoba idatha eyethulwe kuzo zonke izifundo ezintathu iqoqwe ngesikhathi esisodwa kusampula efanayo yabafundi ababambiqhaza.I-athikili yokuqala ibonise izilinganiso zenhloso efanayo (izikolo zokuhlola) phakathi kwe-plastination namaqembu e-3DP [21], futhi isihloko sesibili sasebenzisa ukuhlaziywa kwesici ukuze kuthuthukiswe ithuluzi eliqinisekisiwe ngokwengqondo (izici ezine, izinto eziyi-19) ukukala ukwakhiwa kwezemfundo njengokwaneliseka kokufunda, ukuzethemba, izindinganiso zobuntu, kanye nemikhawulo yokufunda yemidiya [40].Lolu cwaningo luhlole izingxoxo zeqembu ezivulekile nezigxilile zekhwalithi ephezulu ukuze kutholwe ukuthi yini abafundi abayithatha njengebalulekile lapho befunda i-anatomy besebenzisa amasampula epulasitiki namamodeli aphrintiwe e-3D.Ngakho-ke, lolu cwaningo luhlukile ezihlokweni ezimbili zangaphambilini mayelana nezinhloso / imibuzo yocwaningo, idatha, nezindlela zokuhlaziya ukuze uthole ukuqonda mayelana nempendulo yomfundi esezingeni eliphezulu (ukuphawula kombhalo wamahhala kanye nengxoxo yeqembu eligxiliwe) ngokusetshenziswa kwamathuluzi e-3DP uma kuqhathaniswa namasampula epulasitiki.Lokhu kusho ukuthi isifundo samanje sixazulula ngokuyisisekelo umbuzo wocwaningo ohlukile kunezihloko ezimbili ezedlule [21, 40].
Esikhungweni sombhali, i-anatomy ihlanganiswe ezifundweni zesistimu ezifana ne-cardiopulmonary, i-endocrinology, i-musculoskeletal, njll., eminyakeni emibili yokuqala yohlelo lwe-Bachelor of Medicine kanye ne-Bachelor of Surgery (MBBS) lweminyaka emihlanu.Izibonelo eziplastered, amamodeli epulasitiki, izithombe zezokwelapha, namamodeli abonakalayo e-3D avame ukusetshenziswa endaweni yokuhlukaniswa noma izibonelo zokuhlukaniswa okumanzi ukuze kusekelwe umkhuba ovamile we-anatomy.Izikhathi zokufunda ngamaqembu zithatha indawo yezifundo ezifundiswayo ezigxile ekusetshenzisweni kolwazi olutholiwe.Ekupheleni kwemojuli yesistimu ngayinye, thatha isivivinyo sokuzijwayeza sokwakheka kwe-anatomy eku-inthanethi esihlanganisa izimpendulo ezingcono kakhulu ezingama-20 (ama-SBA) ezihlanganisa i-anatomy evamile, imaging, kanye ne-histology.Sekukonke, ukuhlolwa okwakhayo okuhlanu kwenziwa ngesikhathi sokuhlolwa (okuthathu onyakeni wokuqala nezimbili onyakeni wesibili).Ukuhlola okubhaliwe okuhlangene okuhlanganisiwe Kweminyaka 1 no-2 kuhlanganisa amaphepha amabili, ngalinye liqukethe ama-SBA angu-120.I-Anatomy iba yingxenye yalokhu kuhlola futhi uhlelo lokuhlola lunquma inani lemibuzo ye-anatomical okufanele ifakwe.
Ukuze kuthuthukiswe isilinganiso somfundi nesampula, amamodeli angaphakathi e-3DP asuselwe kumasampula enziwe ngepulasitiki afundelwa ukufundisa nokufunda i-anatomy.Lokhu kunikeza ithuba lokuthola ukubaluleka kwemfundo yamamodeli amasha e-3DP uma kuqhathaniswa nezifanekiso ezenziwe ngepulasitiki ngaphambi kokuba zifakwe ngokusemthethweni kukharikhulamu ye-anatomy.
Kulolu cwaningo, i-computed tomography (CT) (64-slice Somatom Definition Flash CT scanner, Siemens Healthcare, Erlangen, Germany) yenziwa kumamodeli epulasitiki enhliziyo (inhliziyo eyodwa yonke nenhliziyo eyodwa esigabeni esiphambanayo) kanye nekhanda nentamo ( eyodwa yonke kanye nenye indiza ye-midsagittal ikhanda-intamo) (Fig. 1).Izithombe zeDigital Imaging and Communications in Medicine (DICOM) zatholwa futhi zalayishwa ku-3D Slicer (izinguqulo 4.8.1 kanye 4.10.2, Harvard Medical School, Boston, Massachusetts) ukuze zihlukaniswe ngokwesakhiwo ngohlobo olufana nemisipha, imithambo yegazi, imizwa, namathambo. .Amafayela ahlukene alayishwa ku-Materialize Magics (Inguqulo 22, Materialize NV, Leuven, Belgium) ukuze kususwe amagobolondo omsindo, futhi amamodeli wokuphrinta alondolozwe ngefomethi ye-STL, abese edluliselwa kuphrinta ye-Objet 500 Connex3 Polyjet (Stratasys, Eden). Prairie, MN) ukuze udale amamodeli e-anatomical e-3D.Ama-resins e-photopolymerizable nama-elastomers abonisa ngale (i-VeroYellow, i-VeroMagenta ne-TangoPlus) yenza ungqimba lube lukhuni ngokwesendlalelo ngaphansi kwesenzo semisebe ye-UV, inikeze isakhiwo ngasinye se-anatomical ukuthungwa nombala kwaso.
Amathuluzi okufunda e-anatomy asetshenziswe kulolu cwaningo.Kwesobunxele: Intamo;kwesokudla: ipuletiwe nenhliziyo ephrintiwe ye-3D.
Ngaphezu kwalokho, i-aorta ekhuphukayo kanye nesistimu ye-coronary yakhethwa kuyo yonke imodeli yenhliziyo, futhi ama-scaffolds ayisisekelo akhiwa ukuze anamathisele kumodeli (inguqulo 22, Materialize NV, Leuven, Belgium).Imodeli yaphrintwa kuphrinta ye-Raise3D Pro2 (i-Raise3D Technologies, i-Irvine, CA) isebenzisa i-thermoplastic polyurethane (TPU) filament.Ukuze kuboniswe imithambo yemodeli, izinto ezisekela i-TPU eziphrintiwe kwadingeka zikhishwe futhi imithambo yegazi ipendwe nge-acrylic ebomvu.
Abafundi bonyaka wokuqala beBachelor of Medicine e-Lee Kong Chiang Faculty of Medicine ngonyaka wezifundo ka-2020-2021 (n = 163, abesilisa abangama-94 nabesifazane abangama-69) bathole isimemo se-imeyili sokubamba iqhaza kulolu cwaningo njengomsebenzi wokuzithandela.Ukuhlolwa okungahleliwe kokuphambana kwenziwa ngezigaba ezimbili, okokuqala ngokusikwa kwenhliziyo bese kuba ngokusika intamo.Kunenkathi yokugeza yamaviki ayisithupha phakathi kwezigaba ezimbili ukuze kuncishiswe imiphumela eyinsalela.Kuzo zombili izigaba, abafundi bebengaboni izihloko zokufunda kanye nezabelo zamaqembu.Abantu abangadluli kwabayisithupha eqenjini.Abafundi abathole amasampula enziwe ngopulasitiki esinyathelweni sokuqala bathole amamodeli e-3DP esinyathelweni sesibili.Esigabeni ngasinye, womabili amaqembu athola isifundo sesethulo (imizuzu engama-30) evela kumuntu wesithathu (uthisha omkhulu) elandelwa ukuzifundela (imizuzu engama-50) esebenzisa amathuluzi okuzifundela anikeziwe kanye nama-handouts.
Uhlu lokuhlola lwe-COREQ (Imibandela Ephelele Yokubika Okufanelekile Kocwaningo) lusetshenziselwa ukuqondisa ucwaningo lwekhwalithi.
Abafundi banikeze impendulo ngempahla yokufunda yocwaningo ngokusebenzisa inhlolovo ehlanganisa imibuzo emithathu evulekile mayelana namandla abo, ubuthakathaka, namathuba okuthuthuka.Bonke abaphendulile abangama-96 banikeze izimpendulo zamahhala.Khona-ke amavolontiya ayisishiyagalombili abafundi (n = 8) abamba iqhaza eqenjini lokugxila.Izingxoxo zenziwa e-Anatomy Training Centre (lapho ukuhlolwa kwenziwa khona) futhi zenziwa uMphenyi wesi-4 (Ph.D.), umfundisi wesilisa ongeyena we-anatomy oneminyaka engaphezu kwe-10 yesipiliyoni sokufundisa i-TBL, kodwa engabandakanyeki eqenjini locwaningo. ukuqeqeshwa.Abafundi bebengazazi izici zomuntu siqu zabacwaningi (noma iqembu locwaningo) ngaphambi kokuqala kocwaningo, kodwa ifomu lemvume labazisa ngenjongo yocwaningo.Umcwaningi 4 kuphela nabafundi ababambe iqhaza eqenjini lokugxila.Umcwaningi uchaze ithimba okugxilwe kulo kubafundi futhi wababuza ukuthi bangathanda yini ukubamba iqhaza.Babelana ngolwazi lwabo lokufunda ukuphrinta kwe-3D nokufakwa kwe-plastination futhi babenomdlandla omkhulu.Umgqugquzeli ubuze imibuzo eyisithupha ehamba phambili ukuze akhuthaze abafundi ukuthi basebenze ngayo (Supplementary Material 1).Izibonelo zifaka phakathi ukuxoxisana ngezici zamathuluzi e-anatomical akhuthaza ukufunda nokufunda, kanye nendima yozwela ekusebenzeni nezifanekiso ezinjalo."Ungakuchaza kanjani ulwazi lwakho lokufunda i-anatomy usebenzisa ama-specimens aqoshiwe namakhophi aphrintiwe e-3D?"kwakuwumbuzo wokuqala kwinhlolokhono.Yonke imibuzo ivulekile, ivumela abasebenzisi ukuthi baphendule imibuzo ngokukhululekile ngaphandle kwezindawo ezichemile, okuvumela idatha entsha ukuthi itholwe kanye nezinselele okufanele zinqotshwe ngamathuluzi okufunda.Abahlanganyeli abatholanga ukuqoshwa kwamazwana noma ukuhlaziywa kwemiphumela.Imvelo yokuzithandela yocwaningo igweme ukugcwaliswa kwesikhala kwedatha.Ingxoxo yonke yaqoshwa ukuze ihlaziywe.
Ukuqoshwa kweqembu okugxilwe kukho (amaminithi angu-35) kulotshiwe izwi nezwi futhi kwahlukaniswa okomuntu (amagama mbumbulu asetshenzisiwe).Ngaphezu kwalokho, imibuzo yohlu lwemibuzo evulekile yaqoqwa.Okulotshiweyo kweqembu eligxilile kanye nemibuzo yenhlolovo yangeniswa kuspredishithi se-Microsoft Excel (Microsoft Corporation, Redmond, WA) ukuze kuhlanganiswe unxantathu wedatha nokuhlanganisa ukuze kuhlolwe imiphumela eqhathanisekayo noma engaguquki noma imiphumela emisha [41].Lokhu kwenziwa ngokuhlaziywa kwethiyori yethiyori [41, 42].Izimpendulo zombhalo zomfundi ngamunye zengezwa enanini lezimpendulo.Lokhu kusho ukuthi amazwana aqukethe imisho eminingi azothathwa njengento eyodwa.Izimpendulo ezithi nil, abekho noma abekho omaka bazozitshwa.Abacwaningi abathathu (umcwaningi wesifazane oneziqu ze-Ph.D., umcwaningi wesifazane oneziqu ze-masters, kanye nomsizi wesilisa oneziqu ze-bachelor kwezobunjiniyela kanye neminyaka engu-1–3 yokuhlangenwe nakho kocwaningo kwezemfundo yezokwelapha) ngokuzimele bafaka amakhodi idatha engahlelekile.Abahleli bohlelo abathathu basebenzisa amaphedi okudweba wangempela ukuze bahlukanise amanothi angemuva kwawo ngokusekelwe kokufana nokwehluka.Amaseshini amaningana ayenziwa ukuze ku-odwe namakhodi eqembu ngokuqashelwa kwephethini ehlelekile nephindaphindwayo, lapho amakhodi aqoqwa ukuze kuhlonzwe izihlokwana (izici ezithile noma ezijwayelekile njengezibaluli ezinhle nezingezinhle zamathuluzi okufunda) okwabe sekwakhiwa izingqikithi ezinkulu [41].Ukuze kufinyelelwe esivumelwaneni, umcwaningi wesilisa oyi-6 (Ph.D.) oneminyaka engu-15 yesipiliyoni sokufundisa i-anatomy ugunyaze izifundo zokugcina.
Ngokuvumelana Nesimemezelo Se-Helsinki, Ibhodi Lokubuyekeza Isikhungo le-Nanyang Technological University (IRB) (2019-09-024) lihlole umthetho olandelwayo wocwaningo futhi lathola ukugunyazwa okudingekayo.Abahlanganyeli banikeze imvume benolwazi futhi baziswe ngelungelo labo lokuhoxa ekubambeni iqhaza nganoma yisiphi isikhathi.
Abafundi abangu-96 bonyaka wokuqala abathola iziqu zobudokotela banikeze imvume enolwazi olugcwele, izibalo zabantu eziyisisekelo ezifana nobulili neminyaka, futhi bamemezele ukuthi akukho ukuqeqeshwa okusemthethweni kwangaphambili kwe-anatomy.Isigaba I (inhliziyo) kanye neSigaba II (i-neck dissection) sihileleke abahlanganyeli be-63 (amadoda angu-33 nabesifazane be-30) nabahlanganyeli be-33 (amadoda angu-18 nabesifazane be-15), ngokulandelana.Iminyaka yabo yayisukela ku-18 kuye kwengama-21 (okusho ukuchezuka okujwayelekile okungu-±: 19.3 ± 0.9) iminyaka.Bonke abafundi abangama-96 baphendule uhlu lwemibuzo (akukho abashiya phakathi), futhi abafundi abayisi-8 babambe iqhaza emaqenjini okugxilwe kuwo.Kube nokuphawula okuvulekile okungu-278 mayelana nobuhle, ububi, kanye nezidingo zokuthuthukiswa.Kwakungekho ukungqubuzana phakathi kwedatha ehlaziywe kanye nombiko wokutholwe.
Kuzo zonke izingxoxo zamaqembu okugxilwe kuwo kanye nezimpendulo zocwaningo, kwavela izindikimba ezine: ubuqiniso obubonwayo, ukuqonda okuyisisekelo nobunkimbinkimbi, izimo zengqondo zokuhlonipha nokukhathalela, ukuhlukahluka, kanye nobuholi (Umfanekiso 2).Isihloko ngasinye sichazwe kabanzi ngezansi.
Izindikimba ezine—ubuqiniso obubonwayo, ukuqonda okuyisisekelo nobunkimbinkimbi, inhlonipho nokunakekela, kanye nokukhetha imidiya yokufunda—zisekelwe ekuhlaziyweni kwendikimba yemibuzo yohlolo oluvulekile kanye nezingxoxo zamaqembu okugxilwe kuwo.Izinto ezisebhokisini eliluhlaza okwesibhakabhaka neliphuzi zimelela izici zesampula ehlanganisiwe kanye nemodeli ye-3DP, ngokulandelanayo.I-3DP = ukuphrinta kwe-3D
Abafundi babe nomuzwa wokuthi izibonelo ezifakwe ngopulasitiki zazingokoqobo kakhulu, zinemibala yemvelo emele kakhulu ama-cadaver wangempela, futhi zazinemininingwane ye-anatomical ecolekile kunamamodeli e-3DP.Isibonelo, i-muscle fiber orientation igqame kakhulu kumasampuli enziwe ngepulasitiki uma kuqhathaniswa namamodeli we-3DP.Lokhu kuqhathanisa kukhonjisiwe esitatimendeni esingezansi.
"Kunemininingwane eminingi futhi kunembile, njengokuvela kumuntu wangempela (umhlanganyeli we-C17; ukubuyekezwa kwe-plastication yamahhala)."
Abafundi baphawule ukuthi amathuluzi e-3DP abelusizo ekufundeni i-anatomy eyisisekelo nokuhlola izici ezinkulu ze-macroscopic, kuyilapho ama-specimens enziwe ngepulasitiki ayelungele ukukhulisa ulwazi lwabo nokuqonda kwezakhiwo eziyinkimbinkimbi ze-anatomical nezifunda.Abafundi babe nomuzwa wokuthi nakuba womabili amathuluzi ayefana ncamashí namanye, ayentula ulwazi olubalulekile lapho esebenza namamodeli e-3DP uma kuqhathaniswa namasampuli afakwe upulasitiki.Lokhu kuchazwe esitatimendeni esingezansi.
“...bekunobunzima obuthile obufana… imininingwane emincane efana ne-fossa ovale… ngokujwayelekile imodeli ye-3D yenhliziyo ingasetshenziswa… entanyeni, mhlawumbe ngizofunda imodeli yokunamathisela ngokuzethemba kakhudlwana (umhlanganyeli PA1; 3DP, ingxoxo yeqembu”) .
“Izakhiwo ezinkulu zingabonwa… ngokuningiliziwe, izibonelo ze-3DP ziwusizo ekutadisheni, ngokwesibonelo, izakhiwo ezimahhadla (kanye) nezinto ezinkulu, ezibonakala kalula njengemisipha nezitho… PA3 umhlanganyeli, 3DP, izingxoxo zeqembu)”.
Abafundi bazwakalise inhlonipho nokukhathazeka okwengeziwe ngezibonelo ezifakwe ngopulasitiki, kodwa futhi babekhathazekile ngokucekelwa phansi kwesakhiwo ngenxa yokuntekenteke nokuntula ukuguquguquka.Ngokuphambene nalokho, abafundi banezela ekuhlangenwe nakho kwabo okungokoqobo ngokuqaphela ukuthi amamodeli e-3DP angenziwa kabusha uma alimala.
“Siphinde futhi siqaphele kakhulu ngamaphethini okufakwa kwe-plastination (umhlanganyeli we-PA2; ukufakwa kwepulasitiki, ingxoxo yeqembu okugxilwe kuyo)”.
“…ngezibonelo zokwenziwa kwe-plastination, kufana…into egcinwe isikhathi eside.Uma ngiyilimaza... ngicabanga ukuthi siyazi ukuthi ibukeka njengomonakalo omkhulu kakhulu ngoba inomlando (umhlanganyeli we-PA3; ukuxutshwa, ingxoxo yeqembu okugxilwe kuyo).
"Amamodeli aphrintiwe e-3D angakhiqizwa ngokushesha futhi kalula...okwenza amamodeli e-3D afinyeleleke kubantu abaningi futhi kube lula ukufunda ngaphandle kokwabelana ngamasampula (umnikeli we-I38; 3DP, ukubuyekezwa kombhalo kwamahhala)."
“…ngamamodeli e-3D singadlala kancane ngaphandle kokukhathazeka kakhulu ngokuwalimaza, njengamasampuli alimazayo… (umhlanganyeli we-PA2; 3DP, ingxoxo yeqembu eligxilile).”
Ngokusho kwabafundi, isibalo sezibonelo ezifakwe ngopulasitiki silinganiselwe, futhi ukufinyelela kwezakhiwo ezijulile kunzima ngenxa yokuqina kwazo.Kumodeli ye-3DP, banethemba lokuqhubeka nokucwenga imininingwane ye-anatomical ngokuhlanganisa imodeli nezindawo zentshisekelo yokufunda komuntu siqu.Abafundi bavumile ukuthi womabili amamodeli enziwe ngepulasitiki nawe-3DP angasetshenziswa ngokuhambisana nezinye izinhlobo zamathuluzi okufundisa njengethebula le-Anatomage ukuze kuthuthukiswe ukufunda.
"Ezinye izakhiwo ezijulile zangaphakathi azibonakali kahle (umhlanganyeli u-C14; ukufakwa kwepulasitiki, ukuphawula kwefomu lamahhala)."
”Mhlawumbe amathebula okuhlolwa kwesidumbu nezinye izindlela kungaba isengezo esiwusizo kakhulu (ilungu C14; uplastination, ukubuyekezwa kombhalo wamahhala).”
"Ngokuqinisekisa ukuthi amamodeli e-3D anemininingwane eminingi, ungaba namamodeli ahlukene agxile ezindaweni ezahlukene kanye nezici ezahlukene, njengemizwa nemithambo yegazi (umhlanganyeli I26; 3DP, ukubuyekezwa kombhalo wamahhala)."
Abafundi baphinde baphakamisa ukuthi kufakwe umboniso wokuthi uthisha achaze indlela yokusebenzisa kahle imodeli, noma iziqondiso ezengeziwe ezithombeni zesampula ezinezichasiselo ukuze kube lula ukutadisha nokuqonda kumanothi ezinkulumo, nakuba bavumile ukuthi ucwaningo beluklanyelwe ngokukhethekile ukuzifundela.
…
”Ochwepheshe bokuqukethwe noma ukuba namathuluzi angeziwe abonakalayo afana nokugqwayiza noma ividiyo kungasisiza siqonde kangcono ukwakheka kwamamodeli e-3D (ilungu C38; ukubuyekezwa kombhalo wamahhala ngokuvamile).”
Abafundi bonyaka wokuqala bezokwelapha babuzwa mayelana nolwazi lwabo lokufunda kanye nekhwalithi yamasampuli e-3D aphrintiwe nawenziwe ngepulasitiki.Njengoba bekulindelekile, abafundi bathole amasampula enziwe ngepulasitiki njengangempela futhi anembe kunalawo aphrintiwe e-3D.Le miphumela iqinisekiswa ucwaningo lokuqala [7].Njengoba amarekhodi enziwa ngezidumbu ezinikelwe, ayiqiniso.Nakuba kwakuwumfanekiso ongu-1:1 wesampula epulasitiki enezici ezifanayo ze-morphological [8], imodeli ephrintiwe ye-3D esekelwe ku-polymer yayibhekwa njengento engokoqobo futhi engeyona engokoqobo, ikakhulukazi kubafundi okwakukhona kubo imininingwane enjengemiphetho ye-oval fossa. akubonakali kumodeli ye-3DP yenhliziyo uma kuqhathaniswa nemodeli epulasitiki.Lokhu kungase kube ngenxa yekhwalithi yesithombe se-CT, esingakuvumeli ukuchazwa okucacile kwemingcele.Ngakho-ke, kunzima ukuhlukanisa izakhiwo ezinjalo ku-software ye-segmentation, ethinta inqubo yokuphrinta ye-3D.Lokhu kungaphakamisa ukungabaza mayelana nokusetshenziswa kwamathuluzi e-3DP njengoba besaba ukuthi ulwazi olubalulekile luzolahleka uma amathuluzi ajwayelekile njengamasampula epulasitiki engasetshenziswa.Abafundi abanentshisekelo yokuqeqeshwa kokuhlinzwa bangase bakuthole kudingekile ukusebenzisa amamodeli asebenzayo [43].Imiphumela yamanje ifana nezifundo zangaphambilini ezithola ukuthi amamodeli epulasitiki [44] kanye namasampula e-3DP awanakho ukunemba kwamasampuli wangempela [45].
Ukuze kuthuthukiswe ukufinyeleleka komfundi kanjalo nokwaneliseka kwabafundi, izindleko nokutholakala kwamathuluzi nakho kufanele kucatshangelwe.Imiphumela isekela ukusetshenziswa kwamamodeli e-3DP ekutholeni ulwazi lwe-anatomical ngenxa yokwakhiwa kwawo okungabizi kakhulu [6, 21].Lokhu kuhambisana nocwaningo lwangaphambilini olubonise ukusebenza kwenhloso efanayo kwamamodeli enziwe ngepulasitiki namamodeli we-3DP [21].Abafundi babe nomuzwa wokuthi amamodeli e-3DP awusizo kakhulu ekutadisheni imiqondo eyisisekelo ye-anatomical, izitho, nezici, kuyilapho ama-specimens apulasitiki afaneleka kakhulu ukutadisha i-anatomy eyinkimbinkimbi.Ngaphezu kwalokho, abafundi bakhuthaze ukusetshenziswa kwamamodeli e-3DP ngokuhambisana nezibonelo ezikhona ze-cadaver kanye nobuchwepheshe besimanje ukuze kuthuthukiswe ukuqonda kwabafundi kwe-anatomy.Izindlela eziningi zokumela into efanayo, ezifana nokwenza imephu ye-anatomy yenhliziyo usebenzisa ama-cadaver, ukuphrinta kwe-3D, ukuskena kwesiguli, namamodeli abonakalayo e-3D.Le ndlela ye-multi-modal ivumela abafundi ukuthi bafanekise i-anatomy ngezindlela ezahlukene, bakhulume ngalokho abakufundile ngezindlela ezihlukene, futhi bahlanganyele abafundi ngezindlela ezahlukene [44].Ucwaningo lubonise ukuthi izinto zokufunda eziyiqiniso ezifana namathuluzi e-cadaver zingaba inselele kwabanye abafundi ngokomthwalo wengqondo ohambisana nokufunda kwe-anatomy [46].Ukuqonda umthelela womthwalo wengqondo ekufundeni kwabafundi nokusebenzisa ubuchwepheshe ukuze kuncishiswe umthwalo wengqondo ukudala indawo yokufunda engcono kubalulekile [47, 48].Ngaphambi kokwethula abafundi ezintweni ze-cadaveric, amamodeli e-3DP angaba indlela ewusizo yokubonisa izici eziyisisekelo nezibalulekile ze-anatomy ukuze kwehliswe umthwalo wokuqonda nokuthuthukisa ukufunda.Ngaphezu kwalokho, abafundi bangathatha amamodeli e-3DP baye nawo ekhaya ukuze abuyekezwe kuhlanganiswe nezincwadi zokufunda nezinto zokufundisa futhi bandise ukufunda kwe-anatomy ngale kwelebhu [45].Kodwa-ke, umkhuba wokukhipha izingxenye ze-3DP awukakaqaliswa esikhungweni sombhali.
Kulolu cwaningo, amasampula afakwe upulasitiki ayehlonishwa kakhulu kune-3DP replicas.Lesi siphetho sihambisana nocwaningo lwangaphambili olubonisa ukuthi izibonelo ze-cadaveric "njengesiguli sokuqala" ziyala inhlonipho nozwela, kuyilapho amamodeli okwenziwa engenzi [49].Izicubu zomuntu ezenziwe ngepulasitiki ezingokoqobo zisondelene futhi zingokoqobo.Ukusetshenziswa kwezinto ze-cadaveric kuvumela abafundi ukuthi bathuthukise izimiso zobuntu nezokuziphatha [50].Ukwengeza, imibono yabafundi ngamaphethini okufakwa kwe-plastination ingase ithintwa ulwazi lwabo olukhulayo lwezinhlelo zokunikela nge-cadaver kanye/noma inqubo yokuplastinisa.I-Plastination inikela ngama-cadaver alingisa uzwela, ukuncoma nokubonga abafundi abakuzwayo ngabanikelayo [10, 51].Lezi zici zihlukanisa abahlengikazi besintu futhi, uma zihlakulelwa, zingabasiza ukuthi bathuthuke ngokomsebenzi ngokwazisa nokuzwelana neziguli [25, 37].Lokhu kuqhathaniswa nabafundisi abathule abasebenzisa i-dissection yomuntu emanzi [37,52,53].Njengoba izibonelo zokufakwa kwepulasitiki zazinikelwe ngama-cadaver, abafundi babezibheka njengabafundisi abathule, okwabangela ukuhlonishwa kwaleli thuluzi elisha lokufundisa.Yize bazi ukuthi amamodeli e-3DP enziwa ngemishini, basakujabulela ukuwasebenzisa.Iqembu ngalinye lizizwa linakekelwe futhi imodeli iphathwa ngokucophelela ukuze kugcinwe ubuqotho bayo.Abafundi kungenzeka sebazi ukuthi amamodeli e-3DP adalwa kusuka kudatha yesiguli ngezinjongo zemfundo.Esikhungweni sombhali, ngaphambi kokuba abafundi baqale ukutadisha okusemthethweni kwe-anatomy, kunikezwa inkambo yesingeniso ye-anatomy yomlando we-anatomy, ngemva kwalokho abafundi bafunge.Inhloso eyinhloko yesifungo ukugxilisa kubafundi ukuqonda amanani obuntu, ukuhlonipha amathuluzi e-anatomical, kanye nobuchwepheshe.Inhlanganisela yezinsimbi ze-anatomical nokuzibophezela kungasiza ukufaka umuzwa wokunakekela, inhlonipho, futhi mhlawumbe ukhumbuze abafundi ngezibopho zabo zesikhathi esizayo ezigulini [54].
Mayelana nentuthuko yesikhathi esizayo yamathuluzi okufunda, abafundi abavela kokubili amaqembu e-plastination kanye ne-3DP bahlanganisa ukwesaba ukucekelwa phansi kwesakhiwo ekuhlanganyeleni kwabo nasekufundeni kwabo.Kodwa-ke, ukukhathazeka mayelana nokuphazamiseka kwesakhiwo samasampula acwetshiwe kwagqanyiswa ngesikhathi sezingxoxo zamaqembu okugxilwe kuwo.Lokhu kubheka kuqinisekiswa izifundo zangaphambilini kumasampula enziwe ngepulasitiki [9, 10].Ukukhohlisa kwesakhiwo, ikakhulukazi amamodeli entamo, kuyadingeka ukuze uhlole izakhiwo ezijulile futhi uqonde ubudlelwano bendawo obunezinhlangothi ezintathu.Ukusetshenziswa kwe-tactile (i-tactile) nolwazi olubonakalayo kusiza abafundi bakhe isithombe sengqondo esinemininingwane eminingi nesiphelele sezingxenye ze-anatomical ezinezinhlangothi ezintathu [55].Ucwaningo luye lwabonisa ukuthi ukuxhaphazwa okuthintekayo kwezinto ezibonakalayo kunganciphisa umthwalo wokuqonda futhi kuholele ekuqondeni okungcono nokugcinwa kolwazi [55].Kuphakanyiswe ukuthi ukwengeza amamodeli e-3DP ngezifanekiso ezenziwe ngepulasitiki kungathuthukisa ukusebenzisana kwabafundi nezifanekiso ngaphandle kokwesaba ukulimaza izakhiwo.
Isikhathi sokuthumela: Jul-21-2023