醫師教育模式之變遷

Changes in the Model of Education for Physicians

謝博生(Bor-Shen Hsieh)

《Journal of Medical Education》 1卷2期 (1997/06) Pp. 3-10

https://doi.org/10.6145/jme.199706_1(2).0002

摘要

醫師養成敎育之現行模式是在西方特殊之文化及環境影響下，逐漸演變而形成，醫師敎育在不同的歷史階段受到不同因素的影響而有不同的模式，影響醫師敎育模式的主要因素包括醫療執業方式、科學技術之進展、以及社會文化環境。西歐早在第9世紀即設立大學，在早期的大學，醫師養成敎育以治療技術為敎學的重點。在12至16世紀，大學裡的醫學敎育受到希臘、羅馬醫學的影響，重視人文敎育及醫學理論，敎學内容涵蓋了哲學、邏輯、人文、疾病理論及醫療技術。17世紀的自然科學發展促進了醫學的進步，大學課程開始納入醫學相關的科學知識和觀念。從18至20世紀，醫師敎育的制度、內容、方法呈現明顯的變遷。在18世紀，以病患為中心的床邊敎學受到重视，醫師敎育朝向理論敎學與實務訓練結合的方向變遷。在19世紀，隨著基礎醫學的進步及臨床醫學的科學化，敎學的重點朝向傳授科學化的疾病理論及診療技術。20世紀中葉開始，科技大量應用於醫療，敎育的重點随著轉變為以科學技術為主的醫療專業訓練。20世紀80年代以後，科技飛躍進步，醫學資訊爆發，醫療環境複雜化，高科技醫療的負面影響逐漸顯现，醫學敎育思潮轉為強調人文社會課程及科學技術課程的均衡，注重解決問題為導向、以學生為中心的啓發式敎學方式，加強醫病關係、健康促進與疾病預防的學習經驗，強調敎師的敎學技巧與輔導角色，並注重全人醫療、人性化醫療及整體性之健康維護，兼顧學生在知識、技術和態度三方面的發展與成長。

關鍵字

醫療 ； 科學 ； 人文

並列摘要

Education for medicine is profoundly influenced by medical practice, science, cultural, and social circumstances. Throughout the twelfth to sixteenth centuries, physicians were educated formally in the university classroom or informally through private study. An innovation in medical education with lasting consequences took place in western Europe in the twelfth and thirteenth centuries. As a result of the rise of universities, medicine was taught in a university setting. The content of the discipline taught by medical faculties of the medieval and Renaissance universities included logic, natural philosophy, and skills acquired by apprenticeship. The university curricula transmitted a body of medical concepts and techniques for medical practice.
The expansion of science and related knowledge made a great impact on medical education in the seventeenth century. Content and concepts from medicine-related science began to be included in the medical curriculum in universities. Teaching clinics were established in the early eighteenth century. Innovative experiments were performed in teaching and research hospitals during the late eighteenth century. Students were placed in charge of wards, caring for patients and keeping medical records. During the early nineteenth century, the hospital moved toward the center of medical education and research. Hospital-based medical education contributed greatly to the development of appropriate diagnostic techniques and the numerical approach to disease and therapeutics.
Science was incorporated into clinical concepts and clinical practice from the middle decades of the nineteenth century. Science courses were added to the student's total educational experience. The apprenticeship was rapidly disappearing by mid-century and medical students were based wholly at the school. Enhanced value was placed on the basic scientific training of medical students by the end of the nineteenth century. The purpose of science teaching was to provide students with the skills and knowledge to equip them with the basis for practicing the best medicine.
Medical advances in the twentieth century have created ethical dilemmas. Knowledge, skills, and a certain humane and wise attitude towards the patient are regarded as the three main characteristics of a good doctor. The importance of the humanities in developing appropriate attitudes of medical students has been stressed in an age of science. Courses in the humanities have been increasingly included as part of the curriculum in medical education. The need to humanize physicians in an increasingly technological age has become a concern of educators by this latter part of the twentieth century.

並列關鍵字

medical practice ； science ； humanities