I-Cadaver Dissection yesiNtu iyancipha, ngelixa i-plastination kunye ne-3D eprintiweyo (i-3DP) imodeli ifumana ukuthandwa njengenye indlela yokufundisa i-anatomy yendabuko.Akucaci ukuba yintoni amandla kunye nobuthathaka bezi zixhobo zitsha kwaye zinokuchaphazela njani amava okufunda e-anatomy yabafundi, abandakanya iinqobo zobuntu ezifana nentlonipho, inkathalo kunye novelwano.
Kwakamsinyane emva kophononongo olungacwangciswanga lokuwela, kwamenywa abafundi abangama-96.Uyilo lwepragmatic lusetyenziselwe ukuphonononga amava okufunda kusetyenziswa i-anatomically plasticized kunye neemodeli ze-3D zentliziyo (Inqanaba 1, n = 63) kunye nentamo (iNqanaba 2, n = 33).Uhlalutyo lwe-thematic inductive lwenziwa ngokusekelwe kwi-278 yokuphononongwa kwesicatshulwa samahhala (ngokubhekiselele kumandla, ubuthathaka, iindawo zokuphucula) kunye nemibhalo ebhaliweyo yamaqela ekugxilwe kuwo (n = 8) malunga nokufunda i-anatomy usebenzisa ezi zixhobo.
Imixholo emine ichongiwe: ukunyaniseka okubonwayo, ukuqonda okusisiseko kunye nokuntsonkotha, izimo zengqondo zentlonipho kunye nenkathalo, ubuninzi beendlela, kunye nobunkokeli.
Ngokubanzi, abafundi bavakalelwa kukuba iisampulu ezenziwe ngeplastikhi zinokwenyani kwaye ke ngoko baziva behlonitshiwe kwaye bekhathalelwe ngakumbi kunemifuziselo ye-3DP, ekulula ukuyisebenzisa kwaye ikufanelekele ngakumbi ukufunda i-anatomy esisiseko.
I-autopsy yomntu ibe yindlela yokufundisa eqhelekileyo esetyenziswa kwimfundo yezonyango ukususela kwinkulungwane ye-17 [1, 2].Nangona kunjalo, ngenxa yokufikelela okulinganiselweyo, iindleko eziphezulu zokugcinwa kwe-cadaver [3, 4], ukunciphisa kakhulu ixesha lokuqeqeshwa kwe-anatomy [1, 5], kunye nenkqubela phambili yezobuchwepheshe [3, 6], izifundo ze-anatomy ezifundiswa ngokusebenzisa iindlela zendabuko ze-dissection ziyancipha. .Oku kuvula amathuba amatsha okuphanda iindlela ezintsha zokufundisa kunye nezixhobo, ezifana nemizekelo yabantu eyenziwe ngeplastikhi kunye ne-3D eprintiweyo (3DP) imodeli [6,7,8].
Ngasinye kwezi sixhobo sineenzuzo kunye neengxaki.Iisampulu ezicandiweyo zomile, azinavumba, ziyinyani kwaye aziyongozi [9,10,11], zizenza zilungele ukufundisa kunye nokubandakanya abafundi kwisifundo kunye nokuqonda i-anatomy.Nangona kunjalo, nazo ziqinile kwaye aziguquguquki kakhulu [10, 12], ngoko zicingelwa ukuba zinzima kakhulu ukuzisebenzisa kunye nokufikelela kwizakhiwo ezinzulu [9].Ngokweendleko, iisampuli zeplastiki zibiza kakhulu ukuthenga nokugcina kuneemodeli ze-3DP [6,7,8].Ngakolunye uhlangothi, iimodeli ze-3DP zivumela ukuthungwa okungafaniyo [7, 13] kunye nemibala [6, 14] kwaye inokwabelwa kwiindawo ezithile, ezinceda abafundi ukuba bachonge ngokulula, bahlule kwaye bakhumbule izakhiwo ezibalulekileyo, nangona oku kubonakala kungaphantsi kweeplastiki. iisampuli.
Izifundo ezininzi ziye zavavanya iziphumo zokufunda / ukusebenza kweentlobo ezahlukeneyo zezixhobo ze-anatomical ezifana neesampuli zeplastiki, imifanekiso ye-2D, amacandelo amanzi, iitafile ze-Anatomage (Anatomage Inc., San Jose, CA) kunye nemizekelo ye-3DP [11, 15, 16], 17, 18, 19, 20, 21].Nangona kunjalo, iziphumo zahluke ngokuxhomekeke ekukhethweni kwesixhobo soqeqesho esisetyenziswe kumaqela olawulo kunye nokungenelela, kunye nokuxhomekeka kwimimandla eyahlukeneyo ye-anatomical [14, 22].Ngokomzekelo, xa isetyenziswe ngokudibeneyo kunye ne-dissection emanzi [11, 15] kunye neetafile ze-autopsy [20], abafundi bachaza ukwaneliseka kokufunda okuphezulu kunye nesimo sengqondo malunga neesampuli ze-plastinated.Ngokufanayo, ukusetyenziswa kweepatheni ze-plastination kubonisa umphumo omuhle wolwazi lwenjongo yabafundi [23, 24].
Iimodeli ze-3DP zihlala zisetyenziselwa ukongeza iindlela zokufundisa zemveli [14,17,21].Loke et al.(2017) ingxelo malunga nokusetyenziswa kwemodeli ye-3DP ukuqonda isifo senhliziyo yokuzalwa kumntwana wezingane [18].Olu pho nonongo lubonise ukuba iqela le-3DP linokwaneliseka kokufunda okuphezulu, ukuqonda okungcono kwe-Fallot's tetrad, kunye nokuphucula amandla okulawula izigulane (ukuzimela) xa kuthelekiswa neqela le-imaging ye-2D.Ukufunda i-anatomy yomthi we-vascular kunye ne-anatomy ye-skull usebenzisa imizekelo ye-3DP inikeza ukwaneliseka kokufunda okufanayo njengemifanekiso ye-2D [16, 17].Ezi zifundo zibonise ukuba iimodeli ze-3DP ziphezulu kwimifanekiso ye-2D ngokumalunga nokwaneliseka kokufunda okubonwa ngabafundi.Nangona kunjalo, izifundo ezithelekisa ngokukodwa iimodeli ze-3DP zezinto ezininzi kunye neesampulu zeplastiki zilinganiselwe.Mogali et al.(2021) isebenzise imodeli yeplastination kunye neemodeli zayo ze-3DP zentliziyo kunye nentamo kwaye yabika ukwanda okufanayo kolwazi phakathi kwamaqela olawulo kunye novavanyo [21].
Nangona kunjalo, ubungqina obuninzi bufunekayo ukuze ufumane ukuqonda okunzulu ukuba kutheni amava okufunda kwabafundi axhomekeke ekukhethweni kwezixhobo ze-anatomical kunye neendawo ezahlukeneyo zomzimba kunye nezitho [14, 22].Amaxabiso obuntu ngumba onomdla onokuchaphazela lo mbono.Oku kubhekiselele kwintlonipho, ukhathalelo, uvelwano kunye novelwano olulindelekileyo kubafundi ababa ngoogqirha [25, 26].Iinqobo zobuntu ziye zafunwa ngokwesiko kwi-autopsy, njengoko abafundi befundiswa ukuba novelwano kunye nokukhathalela izidumbu ezinikelwe, kwaye ke ufundo lwe-anatomy luhlala lukwindawo ekhethekileyo [27, 28].Nangona kunjalo, oku kunqabile ukulinganiswa kwiplastiki kunye nezixhobo ze-3DP.Ngokungafaniyo nemibuzo yokuhlola i-Likert evaliweyo, iindlela zokuqokelela idatha esemgangathweni njengeengxoxo zeqela eligxininisiweyo kunye nemibuzo yophando evulekileyo inika ingqiqo kumagqabaza athatha inxaxheba abhalwe ngokulandelelana ukucacisa impembelelo yezixhobo zokufunda ezitsha kumava abo okufunda.
Ngoko olu phando lujolise ekuphenduleni ukuba abafundi bayibona njani i-anatomy ngokwahlukileyo xa benikwa izixhobo ezimiselweyo (ukufakwa kwe-plastination) ngokuchasene nemifanekiso eprintiweyo ye-3D yomzimba ukuze bafunde i-anatomy?
Ukuphendula le mibuzo ingasentla, abafundi banethuba lokufumana, ukuqokelela kunye nokwabelana ngolwazi lwe-anatomical ngokusebenzisana kweqela kunye nentsebenziswano.Le ngcamango ivumelana kakuhle kunye nethiyori yonxibelelaniso, ngokubhekiselele apho abantu okanye amaqela asekuhlaleni adala kwaye abelane ngolwazi lwabo [29].Ukusebenzisana okunjalo (umzekelo, phakathi koontanga, phakathi kwabafundi kunye nootitshala) kuchaphazela ukwaneliseka kokufunda [30, 31].Kwangaxeshanye, amava okufunda abafundi nawo aya kuphenjelelwa zizinto ezinje ngokufunda lula, okusingqongileyo, iindlela zokufundisa, kunye nomxholo wekhosi [32].Emva koko, ezi mpawu zinokuphembelela ukufunda kwabafundi kunye nobuchule bezihloko ezinomdla kubo [33, 34].Oku kunokunxulunyaniswa nembono yethiyori yepragmatic epistemology, apho isivuno sokuqala okanye ukuqulunqwa kwamava obuqu, ubukrelekrele, kunye neenkolelo kunokugqiba ikhondo elilandelayo lesenzo [35].Indlela yepragmatic icwangciswe ngononophelo ukuchonga izihloko ezintsonkothileyo kunye nokulandelelana kwazo ngodliwano-ndlebe kunye nophando, kulandelwa luhlalutyo lwethimu [36].
Iisampulu zeCadaver zihlala zithathwa njengabacebisi abathuleyo, njengoko zibonwa njengezipho ezibalulekileyo ukuze kuxhamle isayensi nobuntu, intlonipho ekhuthazayo kunye nombulelo ovela kubafundi kubaxhasi babo [37, 38].Izifundo zangaphambili ziye zachaza amanqaku afanayo okanye aphezulu phakathi kweqela le-cadaver / iplastination kunye neqela le-3DP [21, 39], kodwa kwakungacacanga ukuba ngaba abafundi babelana ngamava okufunda afanayo, kubandakanywa neenqobo zobuntu, phakathi kwamaqela amabini.Uphando olongezelelweyo, olu pho nonongo lusebenzisa umgaqo wepragmatism [36] ukuphonononga amava okufunda kunye neempawu zeemodeli ze-3DP (umbala kunye nokuthungwa) kwaye uzithelekise kunye neesampulu ezixutywe ngeplastiki esekelwe kwingxelo yomfundi.
Iimbono zabafundi zinokuphembelela izigqibo zootitshala malunga nokukhetha izixhobo ezifanelekileyo ze-anatomy ngokusekelwe kwinto esebenzayo nengasebenziyo ekufundiseni i-anatomy.Olu lwazi lunokunceda ootitshala bachonge izinto ezikhethwa ngabafundi kwaye basebenzise izixhobo zokuhlalutya ezifanelekileyo ukuphucula amava abo okufunda.
Olu phononongo olusemgangathweni lujolise ekuphononongeni oko abafundi bacinga ukuba ngamava okufunda abalulekileyo besebenzisa iisampuli zentliziyo kunye nentamo yeplastiki xa kuthelekiswa neemodeli ze-3DP.Ngokophononongo lokuqala olwenziwe nguMogali et al.ngo-2018, abafundi bathathela ingqalelo iisampulu eplastithiweyo ukuba yokwenene ngaphezu 3DP imifuziselo [7].Ngoko masicinge:
Ngenxa yokuba i-plastinations yadalwa ukusuka kwi-cadaver yangempela, abafundi kulindeleke ukuba bajonge i-plastinations ngokuncomekayo kunemizekelo ye-3DP ngokobunyani kunye nexabiso lomntu.
Olu pho nonongo luhambelana nezifundo ezimbini zangaphambili zamanani [21, 40] kuba idatha eboniswe kuzo zontathu izifundo ziqokelelwe ngaxeshanye kwisampulu efanayo yabathathi-nxaxheba babafundi.Inqaku lokuqala libonise imilinganiselo yenjongo efanayo (amanqaku okuvavanya) phakathi kweplastination kunye namaqela e-3DP [21], kwaye inqaku lesibini lisebenzise uhlalutyo lwezinto ukuphuhlisa isixhobo esiqinisekisiweyo se-psychometrically (izinto ezine, izinto ze-19) ukulinganisa ukwakhiwa kwemfundo njengokwaneliseka kokufunda, ukuzimela, iinqobo zobuntu, kunye nokufunda imida yemidiya [40].Olu phononongo luphonononge iingxoxo ezikumgangatho ophezulu ezivulelekileyo nezigxininisiweyo zeqela ukufumanisa ukuba abafundi bacinga ukuba yintoni na ibalulekileyo xa befunda i-anatomy besebenzisa iisampulu ezityathiweyo kunye neemodeli eziprintiweyo ze-3D.Ngaloo ndlela, olu pho nonongo luhluke kumanqaku amabini angaphambili malunga neenjongo zophando / imibuzo, idatha, kunye neendlela zokuhlalutya ukuze ufumane ingqiqo malunga neempendulo zabafundi ezisemgangathweni (iinkcazo zetekisi zamahhala kunye nengxoxo yeqela eligxilwe) ekusebenziseni izixhobo ze-3DP xa kuthelekiswa neesampuli zeplastiki.Oku kuthetha ukuba isifundo esikhoyo sisombulula umbuzo wophando olwahlukileyo kunamanqaku amabini angaphambili [21, 40].
Kwiziko lombhali, i-anatomy ihlanganiswe kwiikhosi zenkqubo ezifana ne-cardiopulmonary, i-endocrinology, i-musculoskeletal, njl., kwiminyaka emibini yokuqala ye-Bachelor of Medicine yeminyaka emihlanu kunye ne-Bachelor of Surgery (MBBS) inkqubo.Iisampulu ezityatyiweyo, iimodeli zeplastiki, imifanekiso yezonyango, kunye nemodeli ye-3D enenyani zihlala zisetyenziswa endaweni yokuqhekeka okanye iisampulu ezimanzi eziqhekezayo ukuxhasa ukwenziwa kwe-anatomy ngokubanzi.Iiseshoni zokufunda zamaqela zithatha indawo yeentetho zemveli ezifundiswayo kugxilwe ekusetyenzisweni kolwazi olufunyenweyo.Ekupheleni kwemodyuli yesistim nganye, thatha uvavanyo lokuziqhelanisa ne-online formive anatomy olubandakanya iimpendulo ezizezona zingcono (ii-SBA) ezingama-20 eziquka i-anatomy ngokubanzi, imaging, kunye ne-histology.Lilonke, iimvavanyo zokufundisa ezintlanu zenziwa ngexesha lovavanyo (ezintathu kunyaka wokuqala kunye nezimbini kunyaka wesibini).Uvavanyo oluhlanganisiweyo olubanzi olubhaliweyo lweMinyaka 1 no-2 lubandakanya amaphepha amabini, ngalinye linee-SBA ezili-120.I-Anatomy iba yinxalenye yolu vavanyo kwaye isicwangciso sovavanyo simisela inani lemibuzo ye-anatomical ukuba ibandakanywe.
Ukuze kuphuculwe umlinganiselo womfundi ukuya kwisampulu, imifuziselo yangaphakathi ye-3DP esekwe kwisampulu eyenziwe ngeplastikhi yafundelwa ukufundisa nokufunda i-anatomy.Oku kunika ithuba lokumisela ixabiso lemfundo leemodeli ezintsha ze-3DP xa kuthelekiswa neesampuli ezenziwe ngeplastiki phambi kokuba zibandakanywe ngokusesikweni kwikharityhulam ye-anatomy.
Kolu phononongo, i-computed tomography (CT) (i-64-slice Somatom Definition Flash CT scanner, Siemens Healthcare, Erlangen, eJamani) yenziwa kwiimodeli zeplastiki zentliziyo (intliziyo enye kunye nentliziyo enye kwicandelo elinqamlezayo) kunye nentloko nentamo ( enye yonke kunye enye midsagittal indiza intloko-intamo) (Fig. 1).Imifanekiso yeDigital kunye noNxibelelwano kwiMedicine (DICOM) imifanekiso yafunyanwa kwaye yalayishwa kwi-3D Slicer (iinguqulelo ze-4.8.1 kunye ne-4.10.2, i-Harvard Medical School, i-Boston, i-Massachusetts) yokwahlulwa kwesakhiwo ngohlobo olufana nezihlunu, imithambo, imithambo-luvo, kunye namathambo. .Iifayile ezicandiweyo zilayishwe kwi Materialize Magics (Uguqulelo 22, Materialize NV, Leuven, Belgium) ukususa amaqokobhe engxolo, kunye nemifuziselo yoshicilelo yagcinwa kwifomati ye STL, eyathi ke yakhutshelwa kwiprinta ye Objet 500 Connex3 Polyjet (iStratasys, Eden). Prairie, MN) ukwenza imifuziselo ye-anatomical ye-3D.Iintlaka ezikwaziyo ukufota kunye ne-elastomers ezicacileyo (iVeroYellow, VeroMagenta kunye neTangoPlus) zenza lukhuni umaleko ngokomaleko phantsi kwentshukumo yemitha ye-UV, inika isakhiwo ngasinye se-anatomical ukuthungwa kunye nombala.
Izixhobo zokufunda ze-anatomy ezisetyenzisiweyo kolu phononongo.Ekhohlo: Intamo;ekunene: plated kunye nentliziyo eprintiweyo ye-3D.
Ukongezelela, i-aorta ekhuphukayo kunye nenkqubo ye-coronary yakhethwa kuyo yonke imodeli yentliziyo, kwaye i-scaffolds yesiseko yakhiwe ukuba ifake kwimodeli (inguqulo ye-22, iMaterialize NV, Leuven, Belgium).Imodeli yaprintwa kumshicileli we-Raise3D Pro2 (i-Raise3D Technologies, i-Irvine, CA) usebenzisa i-thermoplastic polyurethane (TPU) i-filament.Ukubonisa i-artery yomzekelo, i-TPU eprintiweyo yokuxhasa izinto kufuneka ikhutshwe kwaye imithwalo yegazi ifakwe nge-acrylic ebomvu.
Abafundi bonyaka wokuqala beBachelor of Medicine kwiLee Kong Chiang Faculty of Medicine kunyaka wezifundo ka-2020-2021 (n = 163, 94 amadoda kunye 69 females) bafumene isimemo se-imeyile sokuthatha inxaxheba kolu phononongo njengomsebenzi wokuzithandela.Uvavanyo olunqamlezileyo lwenziwa kwizigaba ezibini, okokuqala nge-heart incision kwaye emva koko ngentamo yentamo.Kukho isithuba seeveki ezintandathu sokuhlambela phakathi kwamanqanaba amabini ukunciphisa iziphumo ezishiyekileyo.Kuwo omabini amanqanaba, abafundi bebengaboni izihloko zokufunda kunye nezabelo zamaqela.Akukho ngaphezu kwesithandathu abantu kwiqela.Abafundi abafumene iisampulu ezifakwe ngeplastikhi kwinyathelo lokuqala bafumana iimodeli ze-3DP kwinqanaba lesibini.Kwinqanaba ngalinye, omabini la maqela afumana intetho eyintshayelelo (imizuzu engama-30) evela kumntu wesithathu (utitshala omkhulu) elandelwa kukuzifundela (imizuzu engama-50) kusetyenziswa izixhobo zokuzifundela ezibonelelweyo kunye neencwadana ezinemifanekiso.
Uluhlu lokutshekisha lwe-COREQ (Iikhrayitheriya eziBanzi kwiNgxelo yoPhando oluLungileyo) lusetyenziselwa ukukhokela uphando lomgangatho.
Abafundi banike ingxelo malunga nemathiriyeli yokufunda yophando ngophando olubandakanya imibuzo emithathu evulelekileyo malunga namandla abo, ubuthathaka kunye namathuba ophuhliso.Bonke abaphendulayo abangama-96 banike iimpendulo ezingahlawulelwayo.Emva koko amavolontiya abafundi abasibhozo (n = 8) athatha inxaxheba kwiqela ekugxilwe kulo.Udliwano-ndlebe luqhutywe kwiZiko loQeqesho lwe-Anatomy (apho iimvavanyo zenziwa) kwaye zaqhutywa nguMphandi we-4 (Ph.D.), umqeqeshi oyindoda ongeyena we-anatomy oneminyaka engaphezu kwe-10 yamava okuququzelela i-TBL, kodwa engabandakanyekanga kwiqela lokufunda. uqeqesho.Abafundi bebengazazi iimpawu zobuqu zabaphandi (okanye iqela lophando) ngaphambi kokuqala kophononongo, kodwa ifomu yemvume yabazisa ngenjongo yophononongo.Kuphela umphandi 4 kunye nabafundi bathathe inxaxheba kwiqela ekugxilwe kulo.Umphandi uchaze iqela ekugxilwe kulo kubafundi waza wababuza ukuba bangathanda na ukuthatha inxaxheba.Baye babelana ngamava abo okufunda ukuprinta kwe-3D kunye neplastination kwaye babenomdla kakhulu.Umbhexeshi wabuza imibuzo emithandathu ekhokelayo ukukhuthaza abafundi ukuba basebenze kuyo (iMathiriyeli eyoNgezelelweyo 1).Imizekelo ibandakanya iingxoxo ngemiba yezixhobo ze-anatomical ezikhuthaza ukufunda nokufunda, kunye nendima yovelwano ekusebenzeni ngemizekelo enjalo."Ungawachaza njani amava akho okufunda i-anatomy usebenzisa iisampulu eziprintiweyo kunye neekopi eziprintiweyo ze-3D?"ibingumbuzo wokuqala kudliwano ndlebe.Yonke imibuzo ivuliwe, ivumela abasebenzisi ukuba baphendule imibuzo ngokukhululekileyo ngaphandle kweendawo ezicalucalulo, ukuvumela idatha entsha ukuba ifunyenwe kunye nemingeni ukuba yoyiswe ngezixhobo zokufunda.Abathathi-nxaxheba abafumananga ukurekhoda kwamazwana okanye ukuhlalutya kweziphumo.Ubume bokuzithandela bophononongo buthintele ukugcwala kwedatha.Incoko yonke yayibhalwe ukuze kuhlalutywe.
Ukurekhodwa kweqela eligxininisiweyo (imizuzu engama-35) kwabhalwa ngokwezwi nezwi kwaye kwangasetyenziswanga (kwasetyenziswa amagama angengawo).Ukongeza, imibuzo yekhweshine evulelekileyo yaqokelelwa.Imibhalo yeqela ekugxilwe kuyo kunye nemibuzo yovavanyo iye yangeniswa kwi-spreadsheet ye-Microsoft Excel (Microsoft Corporation, Redmond, WA) ukwenzela unxantathu wedatha kunye nokudibanisa ukujonga iziphumo ezithelekisekayo okanye ezingaguqukiyo okanye iziphumo ezitsha [41].Oku kwenziwa ngohlalutyo lwethiyori yethiyori [41, 42].Iimpendulo zetekisi zomfundi ngamnye zongezwa kwitotali yenani leempendulo.Oku kuthetha ukuba amagqabantshintshi anezivakalisi ezininzi aya kuthathwa njengento enye.Iimpendulo nge nil, akukho nanye okanye akukho iithegi zokuphawula aziyi kuhoywa.Abaphandi abathathu (umphandi obhinqileyo onePh.D., umphandi obhinqileyo onesidanga se-masters, kunye nomncedisi oyindoda onesidanga sobunjineli kunye neminyaka eyi-1–3 yamava ophando kwimfundo yezonyango) ngokuzimeleyo ekhowudiweyo idatha engacwangciswanga.Abadwelisi benkqubo abathathu basebenzisa iipads zokwenyani zokuzoba ukuhlula amanqaku asemva kwayo ngokusekwe kwizinto ezifanayo kunye nomahluko.Iiseshoni ezininzi zaqhutyelwa uku-odola kunye neekhowudi zeqela ngokuqatshelwa kwepateni ecwangcisiweyo kunye nokuphindaphinda, apho iikhowudi zaye zadityaniswa ukuchonga ii-subtopics (iimpawu ezithile okanye eziqhelekileyo ezifana neempawu ezintle nezimbi zezixhobo zokufunda) eziye zakha imixholo ebanzi [41].Ukufikelela kwimvumelwano, umphandi oyindoda oyi-6 (Ph.D.) oneminyaka eyi-15 yamava okufundisa i-anatomy uye wavuma izifundo zokugqibela.
Ngokuhambelana neSibhengezo saseHelsinki, iBhodi yokuHlola iZiko leYunivesithi yaseNanyang Technological (IRB) (2019-09-024) ivavanye iprotocol yokufunda kwaye yafumana imvume efunekayo.Abathathi-nxaxheba banike imvume enolwazi kwaye baxelelwa ngelungelo labo lokurhoxa ekuthatheni inxaxheba nangaliphi na ixesha.
Abafundi bezonyango abangamashumi alithoba anesithandathu abenza unyaka wokuqala abangekabinazidanga banike imvume enolwazi olupheleleyo, iinkcukacha zabantu ezifana nesini kunye neminyaka, kwaye babhengeza ukuba akukho qeqesho lusesikweni lwangaphambili kwi-anatomy.Isigaba I (intliziyo) kunye neSigaba sesi-II (i-neck dissection) sibandakanya abathathi-nxaxheba be-63 (amadoda angama-33 kunye nabasetyhini be-30) kunye nabathathi-nxaxheba be-33 (amadoda ayi-18 kunye nabasetyhini be-15), ngokulandelanayo.Iminyaka yabo yayisusela kwi-18 ukuya kwi-21 iminyaka (ithetha ± ukutenxa okusemgangathweni: 19.3 ± 0.9) iminyaka.Bonke abafundi abangama-96 baphendule imibuzo (akukho bayekayo esikolweni), kwaye abafundi abasi-8 bathathe inxaxheba kumaqela ekugxilwe kuwo.Kwakukho izimvo ezivulekileyo ezingama-278 malunga nezinto ezilungileyo, ezimbi, kunye neemfuno zokuphucula.Kwakungekho ukungahambelani phakathi kwedatha ehlalutyiweyo kunye nengxelo yeziphumo.
Kuzo zonke iingxoxo zeqela eligxininisekileyo kunye neempendulo zophando, imixholo emine yavela: ukunyaniseka okubonwayo, ukuqonda okusisiseko kunye nobunzima, izimo zengqondo zentlonipho kunye nenkathalo, i-multimodality, kunye nobunkokeli (Umfanekiso 2).Isihloko ngasinye sichazwe ngokubanzi ngezantsi.
Imixholo emine-ukunyaniseka okubonwayo, ukuqonda okusisiseko kunye nobunzima, intlonipho kunye nenkathalo, kunye nokukhethwa kwimidiya yokufunda-isekelwe kuhlalutyo lwesihloko semibuzo yesaveyi evulelekileyo kunye neengxoxo zeqela eligxininisekileyo.Izinto kwiibhokisi eziluhlaza kunye nephuzi zimele iimpawu zesampuli edibeneyo kunye nemodeli ye-3DP, ngokulandelanayo.3DP = 3D yoshicilelo
Abafundi bavakalelwa kukuba iisampuli ezifakwe ngeplastikhi zinokwenyani ngakumbi, zinemibala yendalo emele i-cadaver yangempela, kwaye ineenkcukacha ze-anatomical ezintle kuneemodeli ze-3DP.Ngokomzekelo, i-muscle fiber orientation ivelele kakhulu kwiisampuli zeplastiki xa kuthelekiswa neemodeli ze-3DP.Lo mahluko uboniswe kwingxelo engezantsi.
”… eneenkcukacha kakhulu kwaye ichanekile, njengomntu wokwenyani (umthathi-nxaxheba weC17; uphononongo lwe-plastination yasimahla).
Abafundi baqaphele ukuba izixhobo ze-3DP ziluncedo ekufundeni i-anatomy esisiseko kunye nokuvavanya iimpawu eziphambili ze-macroscopic, ngelixa iisampuli ezenziwe ngeplastiki zazilungele ukwandisa ulwazi lwabo kunye nokuqonda kwezakhiwo ezintsonkothileyo ze-anatomical kunye nemimandla.Abafundi bavakalelwa kukuba nangona zombini izixhobo bezifana ncakasana, bezilahlekile ulwazi oluxabisekileyo xa besebenza ngeemodeli ze-3DP xa kuthelekiswa neesampulu eziplastisiweyo.Oku kuchazwe kwingxelo engezantsi.
"... bekukho ubunzima obufana ... iinkcukacha ezincinci ezifana ne-fossa ovale ... ngokubanzi imodeli ye-3D yentliziyo inokusetyenziswa ... entanyeni, mhlawumbi ndiya kufunda imodeli yoplastination ngokuzithemba ngakumbi (umthathi-nxaxheba PA1; 3DP, ingxoxo yeqela eligxilileyo") .
Izakhiwo ezinzulu zinokubonwa… ngokweenkcukacha, iisampulu ze-3DP ziluncedo ekufundeni, umzekelo, izakhiwo ezirhabaxa (kunye) nezinto ezinkulu, eziphawuleka ngokulula njengezihlunu kunye namalungu… Umthathi-nxaxheba we-PA3 3DP, ingxoxo yeqela ekugxilwe kuyo)”.
Abafundi babonise intlonipho engakumbi kunye nenkxalabo malunga nemizekelo eyenziwe ngeplastikhi, kodwa babenenkxalabo malunga nokutshatyalaliswa kwesakhiwo ngenxa yobuthathaka kunye nokungabi bhetyebhetye.Ngokuchasene noko, abafundi bongeza kumava abo okusebenza ngokuqaphela ukuba iimodeli ze-3DP zinokuphinda ziveliswe ukuba zonakele.
"Sikwathande ukulumka ngakumbi ngeepateni zokucola (i-PA2 inxaxheba; utyalo, ingxoxo yeqela eligxilileyo)".
“…kwisampulu zotyalo-gazi, kufana…into ebigcinwe ixesha elide.Ukuba ndiyonakalisile… Ndicinga ukuba siyayazi ukuba ikhangeleka njengomonakalo omkhulu ngakumbi kuba inembali (umthathi-nxaxheba we-PA3; iplastination, ingxoxo yeqela eligxilileyo).
"Iimodeli eziprintiweyo ze-3D zinokuveliswa ngokukhawuleza nangokulula ngokwentelekiso...ukwenza iimodeli ze-3D zifikeleleke kubantu abaninzi kwaye kube lula ukufunda ngaphandle kokwabelana ngeesampulu (umxhasi we-I38; 3DP, uphononongo lwasimahla lombhalo)."
“...ngeemodeli ze-3D sinokudlala kancinci ngaphandle kokukhathazeka kakhulu ngokuzonzakalisa, njengeisampulu ezonakalisayo… (umthathi-nxaxheba we-PA2; 3DP, ingxoxo yeqela eligxilileyo).”
Ngokutsho kwabafundi, inani leesampuli ezenziwe ngeplastiki lilinganiselwe, kwaye ukufikelela kwizakhiwo ezinzulu kunzima ngenxa yokuqina kwazo.Kwimodeli ye-3DP, banethemba lokuphucula ngakumbi iinkcukacha ze-anatomical ngokulungelelanisa imodeli kwiinkalo zomdla wokufunda kumntu ngamnye.Abafundi bavumile ukuba zombini iimodeli zeplastiki kunye ne-3DP zinokusetyenziswa ngokudibeneyo nezinye iintlobo zezixhobo zokufundisa ezifana netheyibhile ye-Anatomage ukuphucula ukufunda.
"Ezinye izakhiwo ezinzulu zangaphakathi azibonakali kakuhle (umthathi-nxaxheba u-C14; ukufakwa kweplastination, i-free-form comment)."
"Mhlawumbi iitheyibhile ze-autopsy kunye nezinye iindlela ziya kuba luncedo kakhulu ukudibanisa (ilungu C14; iplastination, ukuphononongwa kwesicatshulwa simahla)."
"Ngokuqinisekisa ukuba iimodeli ze-3D zichazwe kakuhle, unokuba neemodeli ezihlukeneyo ezigxininise kwiindawo ezahlukeneyo kunye neenkalo ezahlukeneyo, ezifana nemithambo-luvo kunye nemithambo yegazi (umthathi-nxaxheba I26; 3DP, ukuphononongwa kombhalo wasimahla)."
Abafundi baphinde bacebise ukubandakanya umboniso wokuba utitshala achaze indlela yokusebenzisa ngokufanelekileyo imodeli, okanye isikhokelo esongezelelweyo kwimifanekiso yesampula echazwe ukuze kube lula ukufunda nokuqonda kumanqaku eentetho, nangona bavuma ukuba isifundo senzelwe ngokukodwa ukuzifundela.
"Ndiyayibulela indlela ezimeleyo yophando ... mhlawumbi isikhokelo esingaphezulu sinokubonelelwa ngohlobo lwezilayidi eziprintiweyo okanye amanqaku athile ... (umthathi-nxaxheba C02; amagqabantshintshi asimahla ngokubanzi)."
"Iingcali zomxholo okanye ukuba nezixhobo ezongezelelweyo ezibonakalayo ezifana noopopayi okanye ividiyo kunokusinceda siqonde ngcono ubume beemodeli ze-3D (ilungu C38; uphononongo lombhalo wasimahla ngokubanzi)."
Abafundi bonyaka wokuqala bezonyango babuzwa malunga namava abo okufunda kunye nomgangatho we-3D eprintiweyo kunye neesampuli zeplastiki.Njengoko bekulindelekile, abafundi bafumene iisampulu zeplastiki zinenyani kwaye zichanekile kunezo ziprintiweyo ze-3D.Ezi ziphumo ziqinisekiswa luphando lokuqala [7].Ekubeni iirekhodi zenziwe kwizidumbu ezinikezelweyo, ziyinyani.Nangona yayiyi-1:1 ikopi yomfanekiso ocandiweyo oneempawu ezifanayo ze-morphological [8], imodeli eprintiweyo ye-3D esekwe kwipolymer yayithathwa njengengenanyani kwaye ingenanyani, ngakumbi kubafundi apho iinkcukacha ezinje ngencam zefossa embhoxo. ayibonakali kwimodeli ye-3DP yentliziyo xa kuthelekiswa nomzekelo owenziwe ngeplastiki.Oku kunokuba ngenxa yomgangatho womfanekiso we-CT, ongavumeli ukucaciswa okucacileyo kwemida.Ke ngoko, kunzima ukwahlula izakhiwo ezinjalo kwisoftware yokwahlulahlula, echaphazela inkqubo yoshicilelo ye-3D.Oku kunokuphakamisa amathandabuzo malunga nokusetyenziswa kwezixhobo ze-3DP njengoko besaba ukuba ulwazi olubalulekileyo luya kulahleka ukuba izixhobo eziqhelekileyo ezifana neesampuli zeplastiki zingasetyenziswanga.Abafundi abanomdla kuqeqesho lotyando banokukufumanisa kuyimfuneko ukusebenzisa imifuziselo ebonakalayo [43].Iziphumo zangoku zifana nezifundo zangaphambili ezifumene ukuba iimodeli zeplastiki [44] kunye neesampuli ze-3DP azikho ukuchaneka kweesampuli zangempela [45].
Ukuze kuphuculwe ukufikeleleka komfundi kwaye ke ngoko ukwaneliseka kwabafundi, iindleko kunye nokufumaneka kwezixhobo kufuneka kuqwalaselwe.Iziphumo zixhasa ukusetyenziswa kweemodeli ze-3DP zokufumana ulwazi lwe-anatomical ngenxa yokwenziwa kweendleko ezisebenzayo [6, 21].Oku kuhambelana nophononongo lwangaphambili olubonise ukusebenza kwenjongo ethelekisayo yeemodeli zeplastiki kunye neemodeli ze-3DP [21].Abafundi bavakalelwa kukuba iimodeli ze-3DP ziluncedo ngakumbi ekufundeni iikhonsepthi ezisisiseko ze-anatomical, amalungu, kunye neempawu, ngelixa iisampuli ezenziwe ngeplastikhi zifaneleke ngakumbi ukufunda i-anatomy entsonkothileyo.Ukongeza, abafundi bakhuthaze ukusetyenziswa kweemodeli ze-3DP ngokusebenzisana nemizekelo ekhoyo ye-cadaver kunye nobuchwepheshe bale mihla ukuphucula ukuqonda kwabafundi kwi-anatomy.Iindlela ezininzi zokumela into enye, njengokuzoba i-anatomy yentliziyo usebenzisa i-cadavers, ushicilelo lwe-3D, ukuskena kwesigulane, kunye neemodeli ze-3D.Le ndlela yeendlela ezininzi ivumela abafundi ukuba babonise i-anatomy ngeendlela ezahlukeneyo, banxibelelane ngento abayifundileyo ngeendlela ezahlukeneyo, kwaye babandakanye abafundi ngeendlela ezahlukeneyo [44].Uphando lubonise ukuba izixhobo zokufunda eziyinyani ezifana nezixhobo ze-cadaver zinokuba ngumngeni kwabanye abafundi ngokomthwalo wokuqonda ohambelana nokufunda i-anatomy [46].Ukuqonda impembelelo yomthwalo wokuqonda ekufundeni kwabafundi kunye nokusebenzisa iteknoloji ukunciphisa umthwalo wokuqonda ukudala indawo yokufunda engcono kubaluleke kakhulu [47, 48].Ngaphambi kokwazisa abafundi kwizinto ze-cadaveric, iimodeli ze-3DP zinokuba yindlela eluncedo yokubonisa imiba esisiseko kunye nebalulekileyo ye-anatomy ukwenzela ukunciphisa umthwalo wokuqonda kunye nokuphucula ukufunda.Ukongeza, abafundi banokuthatha imodeli ye-3DP bagoduke nayo ukuze iqwalaselwe ngokudibeneyo neencwadi zezifundo kunye nezixhobo zokufunda kunye nokwandisa ufundo lwe-anatomy ngaphaya kwelebhu [45].Nangona kunjalo, umkhuba wokususa amacandelo e-3DP awukaphunyezwa kwiziko lombhali.
Kolu phononongo, iisampulu ezicandiweyo zazihlonitshwa ngakumbi kuneekopi ze-3DP.Esi sigqibo sihambelana nophando lwangaphambili olubonisa ukuba i-cadaveric specimens njenge "isigulane sokuqala" siyalela intlonipho kunye novelwano, ngelixa iimodeli ezenziweyo azikho [49].Izicubu zomntu ezityathiweyo zisondele kwaye ziyinyani.Ukusetyenziswa kwemathiriyeli ye-cadaveric kuvumela abafundi ukuba baphuhlise iinjongo zobuntu kunye nemigaqo yokuziphatha [50].Ukongeza, iimbono zabafundi malunga neepateni zokufakwa kweplastination zinokuchatshazelwa lulwazi lwabo olukhulayo lweenkqubo zokunikela nge-cadaver kunye / okanye inkqubo yotyalo.I-Plastination inikezelwa ngee-cadavers ezilinganisa uvelwano, ukuncoma kunye nombulelo abafundi abavakalelwa ngabaxhasi babo [10, 51].Ezi mpawu zahlula abongikazi bobuntu kwaye, ukuba bayalinywa, banokubanceda baqhubele phambili ngobuchwephesha ngokuxabisa kunye novelwano kwizigulane [25, 37].Oku kuthelekiswa nabafundisi abathuleyo basebenzisa i-dissection yabantu emanzi [37,52,53].Ekubeni imizekelo yokuqhotyoshelwa kwakunikelwa ngeengcingo, abafundi babejongwa njengabakhapheli abangathethi nto, nto leyo eyabangela ukuba sihlonelwe esi sixhobo sitsha sokufundisa.Nangona besazi ukuba iimodeli ze-3DP zenziwe ngoomatshini, basakonwabela ukuzisebenzisa.Iqela ngalinye liziva likhathalelwe kwaye imodeli iphathwa ngononophelo ukugcina ingqibelelo yayo.Abafundi basenokuba sele besazi ukuba iimodeli ze-3DP zenziwe kwidatha yesigulane ngeenjongo zemfundo.Kwiziko lombhali, ngaphambi kokuba abafundi baqalise ukufunda ngokusesikweni kwe-anatomy, ikhosi yentshayelelo ye-anatomy yembali ye-anatomy inikwa, emva koko abafundi bafunge.Eyona njongo yesi sifungo kukubethelela kubafundi ukuqonda iinqobo zobuntu, intlonipho yezixhobo ze-anatomical, kunye nobungcali.Ukudityaniswa kwezixhobo ze-anatomical kunye nokuzibophelela kunokunceda ukufaka imvakalelo yokunyamekela, intlonipho, kwaye mhlawumbi ikhumbuze abafundi ngoxanduva lwabo lwexesha elizayo kwizigulane [54].
Ngokubhekiselele kuphuculo lwexesha elizayo kwizixhobo zokufunda, abafundi abavela kuzo zombini iplastination kunye namaqela e-3DP babandakanye uloyiko lokutshatyalaliswa kwesakhiwo kwinxaxheba yabo nokufunda.Nangona kunjalo, iinkxalabo malunga nokuphazamiseka kwesakhiwo sesampulu echongiweyo zaphawulwa ngexesha leengxoxo zeqela ekugxilwe kuzo.Olu qwalaselo luqinisekiswa zizifundo zangaphambili kwiisampuli zeplastiki [9, 10].Ukuguqulwa kwesakhiwo, ngakumbi iimodeli zentamo, ziyimfuneko ukuphonononga izakhiwo ezinzulu kunye nokuqonda ubudlelwane besithuba sesithathu-ntathu.Ukusetyenziswa kwe-tactile (i-tactile) kunye nolwazi olubonakalayo lunceda abafundi ukuba benze umfanekiso wengqondo ocacileyo kunye opheleleyo wezingxenye ezintathu ze-anatomical [55].Uphononongo lubonise ukuba ukuguqulwa kwezinto eziphathekayo kunokunciphisa umthwalo wokuqonda kwaye kukhokelela ekuqondeni okungcono kunye nokugcinwa kolwazi [55].Kuye kwacetyiswa ukuba ukongeza iimodeli ze-3DP kunye neesampuli zeplastiki kunokuphucula intsebenziswano yabafundi kunye nemizekelo ngaphandle kokoyika ukonakalisa izakhiwo.
Ixesha lokuposa: Jul-21-2023