牙醫系應屆畢業生對於兩年期牙醫師畢業後一般醫學訓練的認知、期待及參與意向之初探

前言：隨著醫學進步及疾病的越趨複雜化，以致於醫療專業人員所需要的知識與技能也需不斷的增進，行政院衛生署自2003年起陸續推動西醫師、中醫師畢業後一般醫學訓練計畫（Post-Graduated Year training, 簡稱PGY訓練）臨床訓練制度，銜接學校教育與臨床服務，以提升醫療服務品質。牙醫師臨床訓練制度於2012年7月才推動二年期牙醫師畢業後PGY訓練，此制度施行至今已一年了，但少有相關研究，因此本研究想初步探討牙醫系應屆畢業生(簡稱實習牙醫師)對於此訓練制度的認知、期待及參與意向，希冀能對此制度有所建議。目的：了解牙醫系應屆畢業生對於兩年期牙醫師PGY訓練制度的認知、期待及參與意向之相關因素。方法：研究設計為橫斷式研究，採不記名自填方式結構式問卷調查，研究母全體為101年6月全國實習牙醫師共385位，問卷調查期間自101年05月15~31日，回收有效問卷為303份(回收率78.7%)。研究問卷參考兩年期牙醫師畢業後PGY訓練計劃項目與目的自行發展，內容包括社會人口學、專業訓練地點、牙醫生涯規劃、PGY訓練認知、期待與參與意向等資料。問卷信度在認知題KR20的信度係數0.62；期待題Cronbach's alpha信度係數為0.98。統計使用卡方檢定、獨立樣本t檢定及單因子變異數來探討牙醫師應屆畢業生對於PGY訓練的認知、期待及參與意向之相關因素。結果：研究發現303位實習牙醫師有參與PGY意向者佔229位(75%)，其選擇PGY訓練地點為都會區佔95%；選擇PGY訓練機構為醫院佔63%，選擇聯合訓練佔31%，選擇1個月的口外及急症訓練佔53%。在性別上發現男性有意向參與者佔(78%)略高於女性(71%)，年齡為23-25歲佔85%，就讀私立醫學院校佔77%。牙醫生涯規劃回答將來確定會自行開業80位(26%)中無參與PGY意向者佔9位(12%)，回答將來會想成為專科醫師168位(55%)中無參與PGY意向者佔28位(17%)；實習牙醫師對於PGY制度認知的訓練課程時數、選修訓練幾科及月數、訓練師生比率之答對率為3-4成偏低。對PGY訓練課程期待分析得知: 有參與意向者對於PGY課程含全人訓練課程、PGY社區課程、口外及急症訓練課程，皆顯著高於無參與意向者，其中公立醫學院校的實習牙醫師PGY認知有顯著高於私立者，但課程期待卻顯著低於私立者。結論：實習牙醫師對PGY訓練制度之相關認知偏低，有參與意向者對PGY比較有正面想法與期待，但在有參與意向者對於制度上認知缺乏。因此應該多加強實習牙醫師對於PGY之制度及課程內容的說明，讓實習牙醫師能有充分的了解制度，作適當的決定並達成繼續教育提高醫療品質及臨床訓練之目的。

關鍵字

畢業後一般醫學訓練；醫療品質；牙醫師臨床訓練

並列摘要

Background: With the advances in medical science and the emergence of more and more complex diseases, healthcare professionals need to strengthen their cognition and skills at all times. In order to extend school education to clinical service and to improve healthcare quality, the Department of Health, Executive Yuan, implemented the Post-Graduated Year training (PGY) for physicians and doctors of Chinese medicine in 2003. The 2-year PGY training for dentists was enforced in July 2012. A year after, however, few studies of this training had been done. Therefore, the goals of this preliminary research were to examine cognition, expectation, and participation intention of dental interns regarding this training and to propose suggestions to this educational system. Objectives: To investigate the factors associated with cognition, expectation, and participation intention of dental interns in regard to the 2-year PGY training. Methods: The current research adopted a cross-sectional design. Anonymous self-reported structured questionnaires were administered to a total of 385 dental interns (graduated time: June 2012). The study period was from May 15 to May 31 in 2012. There were 303 valid questionnaires (the response rate was 78.7%). The questionnaire was developed according to the training items and goals of the 2-year PGY program for dentists, which contain information of sociodemographics, training location, and career plan of the dentists as well as cognition, expectation, and participation intention of the PGY training program. The questionnaire had a KR20 coefficient of 0.62 in the cognition items and a Cronbach’s alpha of 0.98 in the expectation items. This study used chi-squared test, independent-sample T test, and ANOVA to investigate the factors associated with cognition, expectation, and participation intention of dental interns in regard to the PGY training. Results: The study found that, among the 303 dental interns, 229 (75%) of them indicated their participation intention to the PGY program. For those who showed their participation intention, 95% chose urban areas, 63% selected hospitals as the training institutes, 31% preferred joint training, and 53% chose one-month oral and emergency training. The proportion of male interns (78%) who showed their participation intention was a bit higher than that of the female interns (71%). 85% of them was in the range of 23 to 25 years of age and 77% of them was from private medical schools. Among the 80 (26%) dental interns who plan to be a private practitioner, 9 (12%) of them showed no intention to join the PGY program. Among the 168 dental interns (55%) who plan to be a dental specialist, 28 (17%) of them showed no intention to join the PGY program. The correct response rates of time spent in training courses, number of optional training subjects, duration (in months) of optional training, and ratio of teaching members to students were in the range of 30% to 40% and were considered low. Analysis on the expectation of PGY training course showed that, compared to those who showed no participation intention, those who showed participation intention had expectation towards whole-person training program, PGY community course, and oral and emergency training course. Dental interns from public medical schools had better cognition and lower expectation of PGY program compared to those from private medical schools. Conclusion: Dental interns lack cognition relevant to PGY training program. Despite those who showed PGY participation intention had more positive thoughts and expectations, they lack cognition of the training program. Therefore, organizing more explanation sessions of PGY training program for the dental interns will help the dental interns better understand this program, make appropriate decisions, and achieve the goals of improving healthcare quality and clinical training through continued education.