國內床邊教學現況探討

Beside Teaching in Taiwan

謝正源(Jane-Yane Shieh) ； 曾榮傑(Rong-Jye Tzeng) ； 王如娥(Carol Ju-O Wang) ； 何善台(Shung-Tai Ho) ； 李世俊(Shih-Chun Lee) ； 張聖原(Sun-Yran Chang)

《Journal of Medical Education》 8卷1期 (2004/03) Pp. 87-96

https://doi.org/10.6145/jme.200403_8(1).0009

摘要

本文參考國外文獻歸納，影響床邊教學的相關因素大致區分為：（1）課程設計：指導者的臨床技能、教學目標（學生需求）、病患（教案）的選擇、教學的技巧、教學的時間；（2）教學環境：軟體（制度面及醫療團隊人員的支持）、硬體設施的配合及（3）學習成效評估等因素。其中影響床邊教學成功與否的要素，須考量教授內容：（1）傳統診斷技巧：病史詢問、身體檢查和溝通技巧；（2）問題導向技巧：基礎醫學知識、實證醫學、自我學習；（3）行政技巧。時間管理、病歷記錄等。另實施床邊教學之障礙：（1）時間壓力；（2）病人不在；（3）病房吵雜；（4）學生臨床技能不足；（5）學生基礎醫學知識不足；（6）病人的焦慮；（7）缺少病房醫療人員之支持，及（8）老師欠缺教學專科領域之外的教學內容等。實施床邊教學應遵守之基本原則：（1）選定教學病例；（2）主動關心學習者；（3）示範專業的臨床推理及技能；（4）提供學習方向和回饋；（5）營造合作的學習環境等五原則。經訪談國內三家醫學中心，藉以了解國內床邊教學執行現況。目前國內床邊教學尚無制度化及是、質化的成效顯現。建議未來在規劃床邊教學時，除考量上述因素外，並應分階段實施，可先選定署定專科，且以該科常見及重要的疾病，優先推行床邊教學，爾後再視各院的指導醫師人力及病人型態逐步擴大實施範圍。以及定期稽核各項教學品質，方能真正落實國內床邊教學品質。

關鍵字

床邊教學 ； 醫學中心

並列摘要

Bed-side teaching is an effective way to learn professional clinical skills. As Sir William Osler says: “To study the phenomena of disease without books is to sail an uncharted sea, whilst to study books without patients is not to go to sea at all.” In other words, beside books and instructors, we also need real patients in clinical education.
In the literature review, we found that the main factors affecting bed-side teaching include: curriculum design (teacher’s professional skills, teaching objectives, anchoring instruction in cases, teaching skills, duration of teaching), learning environment (supported by software and hardware), and evaluation of learning effect. Bed-side teaching is an appropriate way to teach professional skills. These professional skills can be divided into three types: traditional diagnostic skills (history taking, physical examination and communication skills), problem-based skills (basic science, evidence-based medicine and self-directed learning) and administrative skills (time management and record keeping). Eight potential hindrances should be considered in bed-side teaching: time constraints, patient availability, noisy wards, student lack of clinical skills, inadequate students knowledge of basic science, patient anxiety, lack of support from ward staff and clinical teacher’s lack of understanding of what should be taught. There are five general principles for bed-side teaching: anchoring instruction in cases, actively involving learners, modeling professional thinking and action, providing direction and feed back, and creation a collaborative learning environment.
After observing the current status of bed-side instruction at three medical centers in Taiwan, no findings of systematic, quantitative or qualitative effectiveness emerged. Based on these observations, we suggest planning for bed-side teaching in the future not only consider relevant instruction factors but should also be implemented in stages, and that Department of Health designated specialties be chosen, with instruction focused on the most common and important diseases in these areas. Bed-side instruction can then be expanded, depending on individual medical center instructor staffing and patient types. Teaching quality should also be monitored regularly, in order to insure the quality of the bed-side instruction in Taiwan. (Full text in Chinese)

並列關鍵字

bed-side teaching ； medical center

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