Kuphatikizika kwa ma cadaver kwachikale kukucheperachepera, pomwe mitundu ya plastination ndi 3D printed (3DP) ikutchuka ngati njira ina yophunzitsira yachikhalidwe.Sizikudziwika bwino kuti zida zatsopanozi zili ndi mphamvu ndi zofooka zotani komanso momwe zingakhudzire maphunziro a anatomi a ophunzira, omwe amaphatikizapo mfundo zaumunthu monga ulemu, chisamaliro, ndi chifundo.
Atangophunzira mwachisawawa, ophunzira 96 adaitanidwa.Mapangidwe a pragmatic adagwiritsidwa ntchito pofufuza zokumana nazo pophunzira pogwiritsa ntchito mapulasitiki opangidwa ndi pulasitiki ndi ma 3D amtima (Gawo 1, n=63) ndi khosi (Gawo 2, n=33).Kusanthula kwamutu kochititsa chidwi kunachitika kutengera ndemanga zaulere za 278 (ponena za mphamvu, zofooka, madera omwe angasinthidwe) komanso zolembedwa m'mawu amagulu omwe amayang'ana kwambiri (n = 8) pakuphunzira ma anatomy pogwiritsa ntchito zida izi.
Mitu inayi idadziwika: zowona zowona, kumvetsetsa kofunikira ndi zovuta, malingaliro a ulemu ndi chisamaliro, kusiyanasiyana, ndi utsogoleri.
Nthawi zambiri, ophunzira ankaona kuti zitsanzo zomangidwa ndi pulasitala zinali zenizeni ndipo motero ankadzimva kuti amalemekezedwa komanso kusamalidwa kuposa zitsanzo za 3DP, zomwe zinali zosavuta kuzigwiritsa ntchito komanso zoyenera kwambiri pophunzira anatomy.
Kufufuza thupi kwa munthu kwakhala njira yophunzitsira yomwe imagwiritsidwa ntchito pamaphunziro azachipatala kuyambira zaka za zana la 17 [1, 2].Komabe, chifukwa cholephera kupeza, kukwera mtengo kwa kukonza ma cadaver [3, 4], kuchepa kwakukulu kwa nthawi yophunzitsira anatomy [1, 5], ndi kupita patsogolo kwaukadaulo [3, 6], maphunziro a anatomy ophunzitsidwa pogwiritsa ntchito njira zachikhalidwe zakugawikana akuchepa. .Izi zimatsegula mwayi watsopano wofufuza njira zatsopano zophunzitsira ndi zida, monga zitsanzo za anthu opukutidwa ndi zitsanzo za 3D zosindikizidwa (3DP) [6,7,8].
Chilichonse mwa zida izi chili ndi zabwino ndi zoyipa.Zitsanzo zopukutidwa ndi zouma, zopanda fungo, zenizeni komanso sizowopsa [9,10,11], zomwe zimawapangitsa kukhala abwino pophunzitsa komanso kutenga nawo gawo pakuphunzira ndi kumvetsetsa za anatomy.Komabe, amakhalanso olimba komanso osasinthika [10, 12], kotero amawaganizira kuti ndi ovuta kuwongolera ndikufikira zozama [9].Pankhani ya mtengo, zitsanzo za pulasitiki nthawi zambiri zimakhala zodula kugula ndi kusamalira kuposa zitsanzo za 3DP [6,7,8].Kumbali ina, mitundu ya 3DP imalola mawonekedwe osiyanasiyana [7, 13] ndi mitundu [6, 14] ndipo imatha kuperekedwa ku magawo enaake, zomwe zimathandiza ophunzira kuzindikira mosavuta, kusiyanitsa ndi kukumbukira zomanga zofunika, ngakhale izi zikuwoneka kuti sizingachitike kuposa zapulasitiki. zitsanzo.
Kafukufuku wambiri adawunika zotsatira zophunzirira / machitidwe a zida zamitundu yosiyanasiyana monga zitsanzo zapulasitiki, zithunzi za 2D, magawo onyowa, matebulo a Anatomage (Anatomage Inc., San Jose, CA) ndi mitundu ya 3DP [11, 15, 16, 17, 18, 19, 20, 21].Komabe, zotsatira zake zimasiyana malinga ndi kusankha kwa chida chophunzitsira chomwe chimagwiritsidwa ntchito poyang'anira ndi kulowererapo, komanso kutengera madera osiyanasiyana a anatomical [14, 22].Mwachitsanzo, akagwiritsidwa ntchito limodzi ndi kuphatikizika konyowa [11, 15] ndi matebulo a autopsy [20], ophunzira adanenanso za kukhutitsidwa ndi maphunziro apamwamba komanso momwe amaonera zitsanzo zamapulasitiki.Momwemonso, kugwiritsa ntchito njira zopangira pulasitiki kumawonetsa zotsatira zabwino za chidziwitso cha cholinga cha ophunzira [23, 24].
Zitsanzo za 3DP nthawi zambiri zimagwiritsidwa ntchito kuwonjezera njira zophunzitsira zachikhalidwe [14,17,21].Loke et al.(2017) inanena za kugwiritsa ntchito chitsanzo cha 3DP kuti amvetse matenda a mtima wobadwa nawo mwa ana [18].Kafukufukuyu adawonetsa kuti gulu la 3DP linali ndi kukhutira kwamaphunziro apamwamba, kumvetsetsa bwino za tetrad ya Fallot, komanso luso lowongolera odwala (kudzikonda) poyerekeza ndi gulu lojambula zithunzi za 2D.Kuwerenga mawonekedwe a mtengo wa mitsempha ndi mawonekedwe a chigaza pogwiritsa ntchito zitsanzo za 3DP kumapereka kukhutitsidwa kwa kuphunzira komweko monga zithunzi za 2D [16, 17].Maphunzirowa awonetsa kuti mitundu ya 3DP ndi yapamwamba kuposa zithunzi za 2D potengera kukhutira kwamaphunziro komwe ophunzira amawona.Komabe, maphunziro omwe amafanizira mitundu yambiri ya 3DP yokhala ndi zitsanzo zapulasitiki ndi ochepa.Mogali et al.(2021) adagwiritsa ntchito mtundu wa plastination ndi zitsanzo za mtima ndi khosi za 3DP ndipo adanenanso kuwonjezeka kofanana kwa chidziwitso pakati pa magulu olamulira ndi oyesera [21].
Komabe, umboni wochulukirapo ukufunika kuti timvetse mozama chifukwa chake kuphunzira kwa ophunzira kumadalira kusankha kwa zida za anatomical ndi ziwalo zosiyanasiyana za thupi ndi ziwalo [14, 22].Makhalidwe aumunthu ndi gawo losangalatsa lomwe lingakhudze malingaliro awa.Izi zikutanthauza ulemu, chisamaliro, chifundo ndi chifundo zomwe zimayembekezeredwa kuchokera kwa ophunzira omwe amakhala madokotala [25, 26].Makhalidwe aumunthu akhala akufunidwa m'ma autopsies, monga ophunzira amaphunzitsidwa kumvera chisoni ndi kusamalira mitembo yoperekedwa, chifukwa chake maphunziro a anatomy nthawi zonse amakhala ndi malo apadera [27, 28].Komabe, izi sizimayesedwa kawirikawiri mu pulasitiki ndi zida za 3DP.Mosiyana ndi mafunso a kafukufuku wa Likert otsekedwa, njira zosonkhanitsira deta zamtundu wapamwamba monga zokambirana zamagulu ndi mafunso ofufuza otseguka zimapereka chidziwitso pa ndemanga za omwe atenga nawo mbali zolembedwa mwachisawawa kuti afotokoze zotsatira za zida zatsopano zophunzirira pa zomwe akuphunzira.
Ndiye kafukufukuyu ankafuna kuyankha kuti ophunzira amawona bwanji ma anatomy mosiyana akapatsidwa zida zokhazikitsidwa (plastination) motsutsana ndi zithunzi zosindikizidwa za 3D kuti aphunzire zathupi?
Kuti ayankhe mafunso omwe ali pamwambawa, ophunzira ali ndi mwayi wopeza, kudziunjikira ndi kugawana chidziwitso cha anatomical kudzera muzochita zamagulu ndi mgwirizano.Lingaliro ili likugwirizana bwino ndi chiphunzitso cha constructivist, malinga ndi zomwe anthu kapena magulu amagulu amapanga ndikugawana zomwe akudziwa [29].Kuyanjana kotereku (mwachitsanzo, pakati pa anzawo, pakati pa ophunzira ndi aphunzitsi) kumakhudza kukhutira kwamaphunziro [30, 31].Panthawi imodzimodziyo, zomwe ophunzira akuphunzira zidzakhudzidwanso ndi zinthu monga kuphunzira mosavuta, chilengedwe, njira zophunzitsira, ndi zomwe zili mu maphunziro [32].Pambuyo pake, mikhalidwe iyi imatha kukhudza kuphunzira kwa ophunzira ndikuwongolera mitu yomwe ingawasangalatse [33, 34].Izi zitha kukhala zokhudzana ndi malingaliro ongopeka a pragmatic epistemology, pomwe kukolola koyambirira kapena kupanga zochitika zaumwini, luntha, ndi zikhulupiriro zitha kudziwa njira yotsatira [35].Njira ya pragmatic imakonzedweratu kuti izindikire mitu yovuta komanso kutsatizana kwake kudzera muzoyankhulana ndi zofufuza, zotsatiridwa ndi kusanthula kwamutu [36].
Zitsanzo za ma cadaver nthawi zambiri zimatengedwa ngati alangizi osalankhula, chifukwa amawonedwa ngati mphatso zofunikira zopindulitsa sayansi ndi umunthu, zolimbikitsa ulemu ndi kuthokoza kuchokera kwa ophunzira kupita kwa omwe amapereka [37, 38].Kafukufuku wam'mbuyomu adanenanso za zolinga zofanana kapena zapamwamba pakati pa gulu la cadaver / plastination ndi gulu la 3DP [21, 39], koma sizinadziwike ngati ophunzira amagawana zomwe akuphunzira, kuphatikizapo makhalidwe aumunthu, pakati pa magulu awiriwa.Kufufuza kwina, phunziroli limagwiritsa ntchito mfundo ya pragmatism [36] kufufuza zomwe akuphunzira ndi makhalidwe a zitsanzo za 3DP (mtundu ndi mawonekedwe) ndikuziyerekeza ndi zitsanzo zojambulidwa malinga ndi ndemanga za ophunzira.
Malingaliro a ophunzira amatha kukhudza zisankho za aphunzitsi pankhani yosankha zida zoyenera za anatomi kutengera zomwe zili komanso sizothandiza pakuphunzitsa za thupi.Chidziwitsochi chingathandizenso aphunzitsi kuzindikira zomwe ophunzira amakonda ndikugwiritsa ntchito zida zowunikira zoyenera kuti apititse patsogolo maphunziro awo.
Phunziro lapamwambali cholinga chake chinali kufufuza zomwe ophunzira amawona kuti ndizofunika kwambiri pophunzira pogwiritsa ntchito zitsanzo za pulasitiki za mtima ndi khosi poyerekeza ndi zitsanzo za 3DP.Malinga ndi kafukufuku woyamba wa Mogali et al.mu 2018, ophunzira amawona kuti zitsanzo zomangidwa ndi pulasiti zimakhala zenizeni kuposa zitsanzo za 3DP [7].Ndiye tiyeni tiyerekeze:
Poganizira kuti ma plastinations adapangidwa kuchokera ku ma cadavers enieni, ophunzira amayembekezeredwa kuti aziwona pulasitiki bwino kuposa mitundu ya 3DP potengera zowona komanso kufunika kwaumunthu.
Phunziro lapamwambali likugwirizana ndi maphunziro awiri apitalo ochuluka [21, 40] chifukwa deta yomwe inaperekedwa mu maphunziro onse atatu inasonkhanitsidwa nthawi imodzi kuchokera ku chitsanzo chomwecho cha ophunzira ophunzira.Nkhani yoyamba idawonetsanso miyeso yofananira (zoyesa) pakati pa plastination ndi magulu a 3DP [21], ndipo nkhani yachiwiri idagwiritsa ntchito kusanthula kwazinthu kupanga chida chovomerezeka cha psychometrically (zinthu zinayi, zinthu 19) kuyeza zomanga zamaphunziro monga kukhutitsidwa ndi kuphunzira, kudzidalira, zikhulupiriro zaumunthu, ndi zolepheretsa kuphunzira zofalitsa [40].Kafukufukuyu adawunikira zokambirana zamagulu otseguka komanso zowunikira kwambiri kuti adziwe zomwe ophunzira amawona kuti ndizofunikira pophunzira anatomi pogwiritsa ntchito zitsanzo zamapulasitiki ndi mitundu yosindikizidwa ya 3D.Choncho, phunziroli limasiyana ndi nkhani ziwiri zapitazo ponena za zolinga zofufuza / mafunso, deta, ndi njira zowunikira kuti mudziwe bwino za ndemanga za ophunzira zaufulu (ndemanga zaulere komanso zokambirana zamagulu) pakugwiritsa ntchito zida za 3DP poyerekeza ndi zitsanzo zapulasitiki.Izi zikutanthauza kuti kafukufuku wapano amathetsa funso losiyana lofufuza kuposa nkhani ziwiri zam'mbuyomu [21, 40].
Ku bungwe la wolemba, anatomy imaphatikizidwa mu maphunziro a machitidwe monga cardiopulmonary, endocrinology, musculoskeletal, etc., m'zaka ziwiri zoyambirira za pulogalamu ya Bachelor of Medicine ndi Bachelor of Surgery (MBBS).Zitsanzo zopukutidwa, zitsanzo za pulasitiki, zithunzi zachipatala, ndi zitsanzo za 3D nthawi zambiri zimagwiritsidwa ntchito m'malo mwa dissection kapena zonyowa zowonongeka kuti zithandizire machitidwe a anatomy.Maphunziro amagulu amalowa m'malo mwa maphunziro achikhalidwe omwe amaphunzitsidwa ndikugwiritsa ntchito chidziwitso chopezedwa.Pamapeto pa gawo lililonse la dongosolo, tengani mayeso oyeserera a anatomy pa intaneti omwe amaphatikiza mayankho 20 abwino kwambiri (SBAs) okhudza momwe thupi limakhalira, kujambula, ndi histology.Pazonse, mayesero asanu apangidwe adachitidwa panthawi yoyesera (atatu m'chaka choyamba ndi awiri m'chaka chachiwiri).Kuwunika kophatikizana kolembedwa kwa Zaka 1 ndi 2 kumaphatikizapo mapepala awiri, lililonse lili ndi ma SBA 120.Anatomy imakhala gawo la zowunikirazi ndipo dongosolo lowunika limatsimikizira kuchuluka kwa mafunso a anatomical kuti aphatikizidwe.
Pofuna kupititsa patsogolo chiŵerengero cha ophunzira ndi zitsanzo, zitsanzo za mkati za 3DP zochokera ku zitsanzo zojambulidwa zinaphunziridwa kuti aphunzitse ndi kuphunzira momwe anatomy.Izi zimapereka mpata wokhazikitsa phindu la maphunziro la mitundu yatsopano ya 3DP poyerekeza ndi zitsanzo zamapulasitiki zisanaphatikizidwe m'maphunziro a anatomy.
Mu kafukufukuyu, computed tomography (CT) (64-slice Somatom Definition Flash CT scanner, Siemens Healthcare, Erlangen, Germany) inachitidwa pa zitsanzo za pulasitiki za mtima (mtima umodzi ndi mtima umodzi pamtanda) ndi mutu ndi khosi ( imodzi yonse ndi imodzi ya ndege ya midsagittal mutu-khosi) (Mkuyu 1).Zithunzi za Digital Imaging and Communications in Medicine (DICOM) zinapezedwa ndikulowetsedwa mu 3D Slicer (matembenuzidwe 4.8.1 ndi 4.10.2, Harvard Medical School, Boston, Massachusetts) kuti azigawa magawo amtundu monga minofu, mitsempha, mitsempha, ndi mafupa. .Mafayilo agawidwe adakwezedwa ku Materialize Magics (Version 22, Materialize NV, Leuven, Belgium) kuti achotse zipolopolo zaphokoso, ndipo mitundu yosindikizira idasungidwa mumtundu wa STL, womwe kenako adasamutsidwa ku printer ya Objet 500 Connex3 Polyjet (Stratasys, Edeni. Prairie, MN) kuti apange mitundu yofananira ya 3D.Ma resin opangidwa ndi Photopolymerizable ndi ma elastomer owonekera (VeroYellow, VeroMagenta ndi TangoPlus) amaumitsa wosanjikiza ndi wosanjikiza pansi pa ma radiation a UV, kupatsa mawonekedwe aliwonse amtundu wake komanso mtundu wake.
Zida zophunzirira za anatomy zomwe zimagwiritsidwa ntchito mu phunziroli.Kumanzere: Khosi;kumanja: yokutidwa ndi 3D kusindikizidwa mtima.
Kuonjezera apo, kukwera kwa aorta ndi coronary system kunasankhidwa kuchokera ku chitsanzo cha mtima wonse, ndipo scaffolds zapansi zinamangidwa kuti zigwirizane ndi chitsanzo (mtundu wa 22, Materialize NV, Leuven, Belgium).Chitsanzocho chinasindikizidwa pa printer ya Raise3D Pro2 (Raise3D Technologies, Irvine, CA) pogwiritsa ntchito thermoplastic polyurethane (TPU) filament.Kuti awonetse mitsempha yachitsanzocho, zida zothandizira za TPU zomwe zidasindikizidwa zidayenera kuchotsedwa ndipo mitsempha yamagazi idapaka utoto wofiyira wa acrylic.
Ophunzira achaka choyamba a Bachelor of Medicine ku Lee Kong Chiang Faculty of Medicine mchaka cha maphunziro cha 2020-2021 (n = 163, amuna 94 ndi akazi 69) adalandira imelo yoyitanidwa kuti achite nawo kafukufukuyu ngati ntchito yodzifunira.Kuyesera kosasinthika kunachitika m'magawo awiri, choyamba ndi kudulidwa kwa mtima ndiyeno ndi khosi.Pali nthawi yochapira masabata asanu ndi limodzi pakati pa magawo awiriwa kuti muchepetse zotsalira.M'magawo onse awiri, ophunzira anali osawona mitu yophunzirira komanso ntchito zamagulu.Anthu osapitilira sikisi pagulu.Ophunzira omwe adalandira zitsanzo za pulasitiki mu sitepe yoyamba adalandira zitsanzo za 3DP mu sitepe yachiwiri.Pa gawo lirilonse, magulu onse awiri amalandira phunziro loyambira (mphindi 30) kuchokera kwa wina (mphunzitsi wamkulu) wotsatiridwa ndi kudziwerengera (mphindi 50) pogwiritsa ntchito zida zophunzirira zomwe zaperekedwa ndi mapepala.
Mndandanda wa COREQ (Comprehensive Criteria for Qualitative Research Reporting) umagwiritsidwa ntchito kutsogolera kafukufuku wamakhalidwe abwino.
Ophunzira adapereka ndemanga pazophunzirira zofufuzira kudzera mu kafukufuku yemwe anali ndi mafunso atatu otseguka okhudza mphamvu zawo, zofooka zawo, ndi mwayi wawo wachitukuko.Onse 96 omwe adafunsidwa adapereka mayankho aulere.Kenako ophunzira asanu ndi atatu odzipereka (n = 8) adatenga nawo gawo pagulu loyang'ana.Mafunso anachitikira ku Anatomy Training Center (kumene zoyeserazo zinachitikira) ndipo zinachitidwa ndi Investigator 4 (Ph.D.), mlangizi wamwamuna yemwe si wa anatomy yemwe ali ndi zaka zoposa 10 zakuphunzitsidwa kwa TBL, koma osakhudzidwa ndi gulu la kafukufuku. maphunziro.Ophunzirawo sankadziwa makhalidwe a anthu ochita kafukufuku (kapena gulu lofufuza) phunziro lisanayambe, koma fomu yololeza inawauza cholinga cha kafukufukuyu.Ofufuza 4 okha ndi ophunzira adatenga nawo gawo pagulu lowunikira.Wofufuzayo adafotokozera ophunzirawo zomwe akuphunzirazo ndipo adawafunsa ngati angafune kutenga nawo mbali.Iwo adagawana zomwe adakumana nazo pophunzira kusindikiza kwa 3D ndi plastination ndipo anali okondwa kwambiri.Otsogolera adafunsa mafunso asanu ndi limodzi otsogolera kuti alimbikitse ophunzira kuti agwiritse ntchito (Zowonjezera 1).Zitsanzo zikuphatikizapo kukambirana za zida za anatomical zomwe zimalimbikitsa kuphunzira ndi kuphunzira, ndi udindo wachifundo pogwira ntchito ndi zitsanzo zoterezi."Kodi mungafotokoze bwanji zomwe munaphunzira pophunzira za anatomy pogwiritsa ntchito zitsanzo zosindikizidwa ndi 3D?"linali funso loyamba la zokambirana.Mafunso onse ndi otseguka, kulola ogwiritsa ntchito kuyankha mafunso momasuka popanda madera okondera, kulola kuti deta yatsopano ipezeke ndi zovuta kuti zithetsedwe ndi zida zophunzirira.Ophunzira sanalandire zolemba kapena kusanthula zotsatira.Kudzifunira kwa kafukufukuyu kunapewa kuchulukitsa kwa data.Zokambirana zonse zidajambulidwa kuti ziwunikidwe.
Kujambulira kwa gulu loyang'ana (mphindi 35) kudalembedwa liwu ndi liwu ndi kusinthidwa kukhala munthu (ma pseudonyms adagwiritsidwa ntchito).Kuphatikiza apo, mafunso a mafunso otseguka adasonkhanitsidwa.Zolemba za gulu loyang'ana ndi mafunso ofufuza adatumizidwa mu Microsoft Excel spreadsheet (Microsoft Corporation, Redmond, WA) kuti awerenge katatu ndi kuphatikizira deta kuti ayang'ane zotsatira zofanana kapena zofanana kapena zotsatira zatsopano [41].Izi zimachitika pogwiritsa ntchito kusanthula kwamalingaliro [41, 42].Mayankho a malemba a wophunzira aliyense amawonjezeredwa ku chiwerengero cha mayankho.Izi zikutanthauza kuti ndemanga zomwe zili ndi ziganizo zingapo zidzatengedwa ngati imodzi.Mayankho okhala ndi nil, palibe kapena ma tag opanda ndemanga adzanyalanyazidwa.Ofufuza atatu (wofufuza wachikazi yemwe ali ndi Ph.D., wofufuza wamkazi yemwe ali ndi digiri ya masters, ndi wothandizira wamwamuna yemwe ali ndi digiri ya bachelor mu engineering ndi zaka 1-3 za kafukufuku wamaphunziro azachipatala) adasindikiza mopanda deta yosalongosoka.Olemba mapulogalamu atatu amagwiritsa ntchito mapepala ojambulira enieni kuti agawire zolemba zomwe zalembedwa pambuyo pake potengera kufanana ndi kusiyana.Magawo angapo adapangidwa kuti ayitanitsa ndi ma code amagulu kudzera pakuzindikirika mwadongosolo komanso mobwerezabwereza, pomwe ma code adasanjidwa kuti azindikire mitu (zodziwika bwino kapena zodziwika bwino monga zabwino ndi zoyipa za zida zophunzirira) zomwe zidapanga mitu yayikulu [41].Kuti akwaniritse mgwirizano, wofufuza wamwamuna wa 6 (Ph.D.) yemwe ali ndi zaka 15 zakubadwa pophunzitsa anatomy adavomereza maphunziro omaliza.
Mogwirizana ndi Declaration of Helsinki, Institutional Review Board ya Nanyang Technological University (IRB) (2019-09-024) idawunika ndondomeko yophunzirira ndikupeza zilolezo zoyenera.Ophunzira adapereka chilolezo chodziwitsidwa ndipo adadziwitsidwa za ufulu wawo wosiya kutenga nawo mbali nthawi iliyonse.
Ophunzira 96 a chaka choyamba omaliza maphunziro azachipatala adapereka chilolezo chokwanira, kuchuluka kwa anthu monga jenda ndi zaka, ndipo adanenanso kuti sanaphunzirepo kale maphunziro a anatomy.Gawo I (mtima) ndi Phase II (kuphulika kwa khosi) kunaphatikizapo anthu a 63 (amuna 33 ndi akazi a 30) ndi 33 (18 amuna ndi 15 akazi), motero.Zaka zawo zidachokera ku 18 mpaka zaka 21 (kumatanthauza ± kupatuka kokhazikika: 19.3 ± 0.9) zaka.Ophunzira onse 96 adayankha mafunso (palibe osiya maphunziro), ndipo ophunzira asanu ndi atatu adatenga nawo gawo m'magulu owunikira.Panali ndemanga zotseguka za 278 zokhuza zabwino, zoyipa, ndi zofunikira pakuwongolera.Panalibe kusagwirizana pakati pa deta yofufuzidwa ndi lipoti lazofukufuku.
Pazokambirana zonse zamagulu ndi mayankho a kafukufuku, mitu inayi idatuluka: zowona, kumvetsetsa kofunikira ndi zovuta, malingaliro a ulemu ndi chisamaliro, multimodality, ndi utsogoleri (Chithunzi 2).Mutu uliwonse ukufotokozedwa mwatsatanetsatane pansipa.
Mitu inayi—yowona yowona, kumvetsetsa kofunikira ndi zovuta, ulemu ndi chisamaliro, ndi zokonda zophunzirira zoulutsira mawu—zinazikidwa pa kusanthula kwamutu kwa mafunso otseguka a kafukufuku ndi zokambirana zamagulu.Zinthu zomwe zili m'mabokosi abuluu ndi achikasu zimayimira mawonekedwe a zitsanzo zopukutidwa ndi mtundu wa 3DP, motsatana.3DP = 3D kusindikiza
Ophunzirawo ankaona kuti zitsanzo zomangidwa ndi pulasitiki zinali zenizeni, zinali ndi mitundu yachilengedwe yoimira ma cadaver enieni, ndipo zinali ndi tsatanetsatane wa anatomical kuposa zitsanzo za 3DP.Mwachitsanzo, kuyang'ana kwa ulusi wa minofu kumawonekera kwambiri mu zitsanzo zapulasitiki poyerekeza ndi zitsanzo za 3DP.Kusiyanitsa uku kukuwonetsedwa mu mawu omwe ali pansipa.
”…
Ophunzirawo adawona kuti zida za 3DP zinali zothandiza pophunzira ma anatomy ndikuwunika zazikulu zazikuluzikulu, pomwe zitsanzo zapulasitiki zidali zabwino kukulitsa chidziwitso chawo komanso kumvetsetsa kwamitundu ndi zigawo zovuta.Ophunzirawo adawona kuti ngakhale zida zonsezo zinali zofanana ndendende, zinali kusowa chidziwitso chofunikira pogwira ntchito ndi mitundu ya 3DP poyerekeza ndi zitsanzo zamapulasitiki.Izi zikufotokozedwa m'mawu omwe ali pansipa.
"...panali zovuta zina monga ... zing'onozing'ono monga fossa ovale ... kawirikawiri chitsanzo cha 3D cha mtima chingagwiritsidwe ntchito ... pakhosi, mwinamwake ndiphunzira mozama za pulasitiki (wophunzira PA1; 3DP, zokambirana zamagulu") .
”… wochita nawo PA3 3DP, zokambirana zamagulu)”.
Ophunzirawo anasonyeza kulemekeza ndi kudera nkhaŵa kwambiri zitsanzo zomangidwa ndi pulasitiki, koma analinso okhudzidwa ndi kuwonongeka kwa kamangidwe kameneka chifukwa cha kufooka kwake komanso kusowa kusinthasintha.M'malo mwake, ophunzira adawonjezera zomwe adakumana nazo pozindikira kuti zitsanzo za 3DP zitha kupangidwanso ngati zidawonongeka.
”…
"... pazitsanzo za plastination, zili ngati ... chinachake chomwe chasungidwa kwa nthawi yaitali.Ngati ndawononga ...
"Zitsanzo zosindikizidwa za 3D zitha kupangidwa mwachangu komanso mosavuta…kupangitsa kuti mitundu ya 3D ifikire anthu ambiri komanso kupangitsa kuphunzira popanda kugawana zitsanzo (wothandizira I38; 3DP, ndemanga yaulere)."
"... ndi mitundu ya 3D titha kusewera pang'ono osadandaula kwambiri kuti tiwawononge, monga zitsanzo zowononga ... (wotenga nawo mbali PA2; 3DP, zokambirana zamagulu)."
Malingana ndi ophunzirawo, chiwerengero cha zitsanzo zomangidwa ndi pulasitiki ndizochepa, ndipo mwayi wopita kuzinthu zakuya ndizovuta chifukwa cha kukhwima kwawo.Pachitsanzo cha 3DP, akuyembekeza kukonzanso tsatanetsatane wa anatomical posintha chitsanzocho kuti chigwirizane ndi madera omwe ali ndi chidwi pakuphunzira payekha.Ophunzira adavomereza kuti mitundu yonse ya pulasitiki ndi 3DP ingagwiritsidwe ntchito limodzi ndi mitundu ina ya zida zophunzitsira monga tebulo la Anatomage kuti apititse patsogolo kuphunzira.
"Zizindikiro zina zamkati siziwoneka bwino (wotenga nawo mbali C14; plastination, ndemanga yaulere)."
"Mwina matebulo a autopsy ndi njira zina zingakhale zothandiza kwambiri (membala C14; plastination, ndemanga yaulere)."
"Poonetsetsa kuti zitsanzo za 3D ndizofotokozedwa bwino, mukhoza kukhala ndi zitsanzo zosiyana zomwe zimayang'ana madera osiyanasiyana ndi mbali zosiyanasiyana, monga mitsempha ndi mitsempha ya magazi (wotenga nawo mbali I26; 3DP, ndemanga yaulere)."
Ophunzira adaperekanso chionetsero kuti mphunzitsi afotokoze momwe angagwiritsire ntchito bwino chitsanzocho, kapena chitsogozo chowonjezera pazithunzi zojambulidwa kuti athe kuphunzira ndi kumvetsetsa muzolemba zamaphunziro, ngakhale adavomereza kuti phunziroli linapangidwa kuti azidziwerengera okha.
"Ndimayamikira njira yodziyimira payokha ...mwinanso malangizo ochulukirapo atha kuperekedwa ngati zithunzi zosindikizidwa kapena zolemba zina ...
"Akatswiri okhutira kapena kukhala ndi zida zowonjezera zowonera monga makanema ojambula pamanja kapena makanema kungatithandize kumvetsetsa bwino mawonekedwe amitundu ya 3D (membala C38; ndemanga zaulere zonse)."
Ophunzira azachipatala a chaka choyamba adafunsidwa za zomwe adaphunzira komanso mtundu wa zitsanzo za 3D zosindikizidwa komanso zapulasitiki.Monga zikuyembekezeredwa, ophunzirawo adapeza kuti zitsanzo zapulasitiki zinali zenizeni komanso zolondola kuposa zosindikizidwa za 3D.Zotsatira izi zimatsimikiziridwa ndi kafukufuku woyambirira [7].Popeza zolembazo zimapangidwa kuchokera ku mitembo yoperekedwa, ndizowona.Ngakhale inali chithunzi cha 1: 1 cha chojambula chopakidwa chokhala ndi mawonekedwe ofanana ndi mawonekedwe a morphological [8], chosindikizira chopangidwa ndi polima cha 3D chinkawoneka ngati chosatheka komanso chosatheka kwenikweni, makamaka kwa ophunzira omwe m'mbali mwa oval fossa anali. zosaoneka mu 3DP chitsanzo cha mtima poyerekeza ndi pulasitiki chitsanzo.Izi zikhoza kukhala chifukwa cha khalidwe la chithunzi cha CT, chomwe sichilola kulongosola momveka bwino malire.Chifukwa chake, ndizovuta kugawa magawo oterowo pamapulogalamu amagawo, omwe amakhudza kusindikiza kwa 3D.Izi zitha kuyambitsa kukayikira za kugwiritsa ntchito zida za 3DP chifukwa akuopa kuti chidziwitso chofunikira chidzatayika ngati zida zokhazikika monga zitsanzo zapulasitiki sizigwiritsidwa ntchito.Ophunzira omwe ali ndi chidwi ndi maphunziro a opaleshoni atha kuona kuti ndikofunikira kugwiritsa ntchito zitsanzo zabwino [43].Zotsatira zamakono zikufanana ndi maphunziro apitalo omwe anapeza kuti zitsanzo za pulasitiki [44] ndi 3DP zitsanzo zilibe zolondola za zitsanzo zenizeni [45].
Pofuna kupititsa patsogolo kupezeka kwa ophunzira komanso kukhutira kwa ophunzira, mtengo ndi kupezeka kwa zida ziyeneranso kuganiziridwa.Zotsatira zimathandizira kugwiritsa ntchito mitundu ya 3DP kuti mupeze chidziwitso cha anatomical chifukwa cha kupanga kwawo kopanda mtengo [6, 21].Izi zikugwirizana ndi kafukufuku wam'mbuyomu yemwe adawonetsa magwiridwe antchito ofanana amitundu yamapulasitiki ndi mitundu ya 3DP [21].Ophunzira ankaona kuti zitsanzo za 3DP zinali zothandiza kwambiri pophunzira mfundo zoyambira za thupi, ziwalo, ndi mawonekedwe ake, pamene zitsanzo zomangidwa ndi pulasititi zinali zoyenera kwambiri pophunzira za anatomy zovuta.Kuphatikiza apo, ophunzira adalimbikitsa kugwiritsa ntchito mitundu ya 3DP molumikizana ndi zitsanzo zomwe zilipo kale komanso umisiri wamakono kuti ophunzira amvetsetse bwino za thupi.Njira zingapo zowonetsera chinthu chomwecho, monga kupanga mapu a mtima wamtima pogwiritsa ntchito ma cadaver, kusindikiza kwa 3D, ma scan a odwala, ndi zitsanzo za 3D.Njira yamitundu yambiriyi imalola ophunzira kufotokoza momwe thupi limakhalira m'njira zosiyanasiyana, kufotokoza zomwe aphunzira m'njira zosiyanasiyana, ndikuphatikiza ophunzira m'njira zosiyanasiyana [44].Kafukufuku wasonyeza kuti zida zophunzirira zenizeni monga zida za cadaver zitha kukhala zovuta kwa ophunzira ena potengera kuchuluka kwa chidziwitso komwe kumakhudzana ndi kuphunzira kwa anatomy [46].Kumvetsetsa momwe chidziwitso chazidziwitso chimakhudzira kuphunzira kwa ophunzira ndikugwiritsa ntchito matekinoloje kuti muchepetse chidziwitso kuti mupange malo abwino ophunzirira ndikofunikira [47, 48].Asanadziwitse ophunzira ku zinthu za cadaveric, zitsanzo za 3DP zitha kukhala njira yothandiza yowonetsera zofunikira komanso zofunikira za thunthu la thupi kuti muchepetse kuchuluka kwa chidziwitso ndikukulitsa kuphunzira.Kuphatikiza apo, ophunzira atha kupita ndi mitundu ya 3DP kunyumba kuti akawunikenso kuphatikiza mabuku ndi zida zophunzirira ndikukulitsa maphunziro a anatomy kupitilira labu [45].Komabe, mchitidwe wochotsa zigawo za 3DP sunakwaniritsidwebe mu bungwe la wolemba.
Mu kafukufukuyu, zitsanzo zomangidwa ndi pulasiti zimalemekezedwa kwambiri kuposa 3DP replicas.Izi zikugwirizana ndi kafukufuku wam'mbuyomu wosonyeza kuti zitsanzo za cadaveric monga "wodwala woyamba" zimalamula ulemu ndi chifundo, pamene zitsanzo zopanga sizitero [49].Minofu yamunthu yopangidwa ndi pulasitiki ndi yapamtima komanso yowona.Kugwiritsa ntchito zinthu za cadaveric kumathandizira ophunzira kukhala ndi malingaliro aumunthu komanso amakhalidwe abwino [50].Kuphatikiza apo, malingaliro a ophunzira pakupanga mapatanidwe amatha kukhudzidwa ndi chidziwitso chawo chomwe chikukulirakulira cha mapulogalamu opereka ma cadaver ndi/kapena plastination.Plastination ndi ma cadavers omwe amatsanzira chifundo, kusilira ndi kuthokoza komwe ophunzira amamvera chifukwa cha omwe amapereka [10, 51].Makhalidwewa amasiyanitsa anamwino aumunthu ndipo, ngati atalimidwa, amatha kuwathandiza kupita patsogolo mwaluso poyamikira ndi kumvera chisoni odwala [25, 37].Izi zikufanana ndi aphunzitsi osalankhula omwe amagwiritsa ntchito kupha anthu konyowa [37,52,53].Popeza kuti zitsanzo zopendekerazo zinali zoperekedwa kuchokera ku mikwingwirima, ophunzirawo ankaziona ngati aphunzitsi osalankhula, zomwe zinachititsa kuti chida chophunzitsira chatsopanochi chilemekezedwe.Ngakhale akudziwa kuti mitundu ya 3DP imapangidwa ndi makina, amasangalalabe kuzigwiritsa ntchito.Gulu lirilonse limamva kusamalidwa ndipo chitsanzocho chimasamalidwa mosamala kuti chiteteze kukhulupirika kwake.Ophunzira atha kudziwa kale kuti mitundu ya 3DP imapangidwa kuchokera ku data ya odwala pazolinga zophunzitsira.Kusukulu ya mlembi, ophunzira asanayambe maphunziro a anatomy, maphunziro oyambirira a mbiri ya anatomy amaperekedwa, kenako ophunzirawo alumbira.Cholinga chachikulu cha lumbiroli ndikuphunzitsa ophunzira kumvetsetsa za umunthu, kulemekeza zida za thupi, ndi ukatswiri.Kuphatikizika kwa zida za anatomical ndi kudzipereka kungathandize kulimbikitsa chidwi, ulemu, mwinanso kukumbutsa ophunzira za udindo wawo wamtsogolo kwa odwala [54].
Pankhani ya kusintha kwamtsogolo kwa zida zophunzirira, ophunzira ochokera m'magulu a plastination ndi 3DP adaphatikiza mantha owononga dongosolo mukutenga nawo gawo ndi kuphunzira kwawo.Komabe, zodetsa nkhawa za kusokonezeka kwa kapangidwe ka zitsanzo zojambulidwa zidawonetsedwa pazokambirana zamagulu.Kuwona uku kumatsimikiziridwa ndi maphunziro am'mbuyomu pa zitsanzo zapulasitiki [9, 10].Zosintha zamapangidwe, makamaka zitsanzo zapakhosi, ndizofunikira kuti mufufuze zozama ndikumvetsetsa maulalo amitundu itatu.Kugwiritsiridwa ntchito kwa tactile (tactile) ndi chidziwitso chowoneka kumathandiza ophunzira kupanga chithunzithunzi chathunthu chamagulu atatu a anatomical [55].Kafukufuku wasonyeza kuti kusinthasintha kwa zinthu zakuthupi kumatha kuchepetsa chidziwitso ndikupangitsa kumvetsetsa bwino komanso kusunga chidziwitso [55].Zanenedwa kuti kuwonjezera zitsanzo za 3DP zokhala ndi zitsanzo zapulasitiki kungapangitse kuti ophunzira azigwirizana ndi zitsanzozo popanda kuopa kuwononga nyumbazo.
Nthawi yotumiza: Jul-21-2023