安寧緩和醫療教育課程對醫學生知識與態度之影響： 從2007到2011年某醫學院之調查研究

The influence from palliative care education on the knowledge and attitude of medical students: a medical school survey from 2007 to 2011

林晏群(Yen-Chun Lin)

指導教授 ： 蔡篤堅

共同指導教授 ： 胡文郁

臺北醫學大學/人文暨社會科學院/醫學人文研究所/碩士(2013年)

https://doi.org/10.6831/TMU.2013.00015

摘要

安寧緩和醫療是照護末期生命最重要的選項，醫學教育近十年逐漸增加安寧緩和醫療課程，也致力於評量醫學院學生對於末期照護的知識、態度和臨床技能。對此有助於觀念推廣，精緻醫護人員素質與知能，對於改善末期照護品質有很大的幫助，且進一步發展成臨床教學指引與成果評量的依據。而目前多數的文獻皆是對單一課程成效的論述，就課程短期成效而言，發表者皆有顯著性的成效，但對於長時間學習成效的追蹤研究仍相當匱乏。
本研究旨在瞭解醫學系學生與畢業生對於安寧緩和醫療知識及安寧緩和醫療倫理情境態度改變、及探討影響這些有機會接受安寧教育和相關訓練的新生代醫師們對安寧緩和醫療知識與安寧緩和醫療倫理情境態度改變之相關因素，以及這些改變與末期照顧臨床能力之相關性。為描述性縱貫式調查研究(longitudinal survey)，以結構性問卷(structured questionnaires)收集資料，採取方便立意取樣方式聯繫北部某醫學大學之醫學生與畢業生，共回收有效問卷共138份。研究工具包括：醫學生緩和醫療認知問卷、末期照護臨床能力自評量表及課程評估量表。以SPSS16.0建立資料與統計分析。
本研究重要結果如下：1.這些新生代醫師與準醫師們安寧緩和醫療知識答對率比較醫五課程後測成績，雖有下降但無達到顯著；2.他們安寧緩和醫療倫理態度分數較醫五後測分數高，表示安寧緩和醫療醫學教育有其延續性；3.影響其知識及倫理態度改變與少部分社會人口學變項及學習經驗有顯著差異；4.倫理態度之改變與末期照顧臨床能力有顯著正向相關。
結論為醫學系學生與畢業生之安寧緩和醫療知識、倫理態度，可透過繼續教育與經驗務實的臨床體驗，延續及維持在醫學院教育所培育的安寧緩和醫療知識及態度，其中末期照顧經驗扮演非常關鍵性的角色。

關鍵字

安寧緩和醫療 ； 醫學教育 ； 追蹤研究

並列摘要

Palliative/hospice care has been considered the most appropriate model of care for terminal patients, and medical education concerning palliative/hospice care has been increasing in the last three decades, that medical students should learn palliative/hospice care has been incorporated into the curriculum. Assessment of medical students in terms of their palliative/hospice care knowledge, attitudes and clinical skills will not only help to improve the quality of end-of-life care, but should also be included in the guidelines of teaching outcomes in medical schools. However, most of the literature and research projects discuss only the effectiveness of short-term training courses.
The study reported in this thesis located 138 medical students, graduate medical students, and medical residents, who had completed a one-day palliative/hospice medicine course in their fifth year in medical school, and asked them to complete a follow-up questionnaire. The main goal of this research was: (1) what is the palliative/hospice knowledge and ethical attitudes changed; (2) what are the factors that lead to change medical students in the palliative/hospice care knowledge and attitudes; (3) what is the relationship between the palliative/hospice care knowledge and attitudes of the students, and their clinical competence in end-of-life care?
The study results showed that: (1) Medical students rating on palliative/hospice care knowledge has decreased over this time, but it is not statistically significant; (2) their ethical attitude score was higher than their one-day training post-test scores, which means that the palliative/hospice care education has achieved; (3) the change in knowledge and ethical attitudes significantly related to a small number of social-demographic variables and learning experiences, such as internship and service learning; (4) the change in ethical attitudes was significant positive correlation with clinical competency of end-of-life care.
In conclusion, this study indicates that education in palliative/hospice care for medical students will maintain their palliative/hospice care knowledge and ethical attitudes, and enhance their clinical competence of end-of-life care.

並列關鍵字

palliative/hospice care ； medical education ； follow-up study

參考文獻

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