牙科住院醫師對病患整體口腔醫療的教學意見與評估

台大醫院牙科部自九十年開始實施第一年住院醫師病患「整體口腔醫療」（total patient care, TPC）訓練，即將屆滿兩年，為了瞭解訓練制度改變的影響與受訓醫師對新訓練方式的意見與成效，本研究設計三十題的問卷調查，內容包含：對訓練的場地、師資、器械與儀器的使用、助理的使用與關係、病人治療方式、病人預約的長短、醫病關係的好壞、與同儕之間的關係、教學方式、學習成果的被評估，與對主治醫師的跟診學習狀況等。共有14位第一年住院醫師與7位第二年住院醫師受測。結果顯示受訓場地不足且需集中，指導老師（主要由各專科指派）經過一年的改善目前尚嫌不足，受訓醫師最希望增加矯正科指導老師；且表示很需牙科助理的幫忙，顯示目前門診助理的不足。最大的滿意度顯現在病人治療方式與醫病關係的改善。最不滿意的地方在學習成果的被評估與對主治醫師的跟診學習。評估總學習成效，第一年住院醫師為3.71+0.59，第二年住院醫師為2.43+0.53，兩者間具明顯差異（p=0.001）；經過一年的制度修正改善許多，且改善的學習成效，病例討論會優於文獻討論會。除了學習成效的改進，較明顯的差異出現在同儕之間關係的改進，兩年間具明顯差異（p=0.001）。有一半的受訓醫師認為TPC本來應可以擴展至兩年的訓練，另一半認為一年已足夠。台大牙科部實施牙科病患整體醫療兩年，受訓醫師的學習成效已明顯改善，未來若場地容許可考慮擴展訓練期間至兩年，訓練場地、助理、指導老師及整體教學方法仍有很大的改進空間。

關鍵字

病患整體口腔醫療；學士後一般牙科訓練；一般牙科高階教育

並列摘要

Total patient care (TPC) has now been taught in the first year residency of the National Taiwan University Hospital (NTUH) dental department for the last two years. In order to assess the impact of this new training system, trainee opinions were sought. A questionnaire was administered that addressed satisfaction with training facilities, the teaching faculty, patient management, doctor-patient relationships, relationships between colleagues, trainee assessment and assistance with learning. In total, 14 first year residents (R1) and seven second year residents (R2) completed the questionnaire. Results showed that the training location was felt to require improvement. The teaching faculty was felt to be insufficient and future involvement of specialists from orthodontic departments was suggested. The urgent need for dental assistants in the clinic was made clear. Respondents expressed the greatest satisfaction with patient management and doctor-patient relationships while expressing the least satisfaction with trainee assessment and assistance with learning. The mean ranking of overall learning in R1 was 3.71+0.59, whereas in R2 it was 2.43+0.53 (the sum of learning obtained). There was a statistically significant difference between them when compared with the Mann-Whitney U test (p=0.001). Half of the trainees felt that TPC training could be extended to two years in future, while the other half felt that one year was sufficient. After two years of TPC resident training in the dental department of NTUH, a significant improvement in overall learning and patient management has been achieved based on the overall results of questionnaires. There is nevertheless significant scope for improvement in the training facilities, teaching faculty and teaching methods at NTUH.

並列關鍵字

Total patient care ； postgraduate general dentistry ； advanced general dentistry education

參考文獻

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牙科住院醫師對病患整體口腔醫療的教學意見與評估

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