醫學生社會化影響因素之探討

A Study on Factors Influencing Socialization of Medical Students

季瑋珠(Wei-Chu Chie) ； 楊志良(Chih-Liang Yaung)

《中華民國公共衛生學會雜誌》 5期 (1985/09) Pp. 3-23

https://doi.org/10.6288/JNPHARC1985-05-01-01

摘要

為瞭解目前台灣地區醫學生的社會化過程及其影響因素，發掘其中的問題，以對國內的醫學教育提供具體的建議，吾人就以下五方面：(1)學校機構特徵；(2)家庭及個人基本的特徵；(3)習醫過程的生活與適應；(4)價值觀念與態度；(5)專業生涯選擇與期望，以問卷調查了台大與高醫醫學糸一、四、七，三個年級的學生，結果要點如下：
1．學校社會人文科學訓練不足，缺乏生動實用的人道精神教育，過度強調尖端科技及精密儀器，將成就和發展侷限於高度專料分化始教學醫院，尤以台大為然，這些都是致使醫學生與社會需求脫節之因子。
2．醫學生以男性(88.4%)及本地生(70.0%)為主。醫學生多來自地位優越的家庭（例如：出生於都市化程度在省轄市及以上的醫學生占44.4%，家庭之社會經濟地位在Ⅰ及Ⅱ位者，各占19.0%及28.0%），且有醫師之家族聚集傾向（家族中有醫師者占46.7%）此顯示醫學生之生活背景與一般社會大衆有相當距離；醫學生入學前多經過激烈的升學競爭與淘汰（高中有40.0%，畢業於建中或北一女中，71.7%參加過補習，有55.3%曾經重考），尤以台大為然。
3．醫學生自覺的人際關係尚稱健全，但休閒活動及壓力適應呈現不少問題。主要的壓力來源在低年級多屬人格發展及生活適應問題，高年級則加上專業問題，適應方法多採自已摸索，次為訴諸關係親密的朋友、家人、或師長、學長。座談討論及課堂講授的方式甚少使用，高醫在習醫過程生活及適應上，較台大略為健全。
4．個人習醫期望隨年級漸趨現實，但仍以教人服務(87.5%)、學術成就(68.1%)與穩定生活(58.6%)為重。醫師角色方面，偏好傳統認定夠醫學與社會角色，但高年級社會角色傾向較高，而台大醫學生之期望較偏離傳統。有97.6%的人認為醫療工作有賴團隊合作，44.4%的人認為領導者不一定須白醫師擔任。醫學生認為理想醫師的社會人文素養應占全部素養的39.1%（標準差12.0%）。
5．80.8%的醫學生在初步專業生涯，80.0%在穩定專業生涯選擇期望從事臨床醫學，且比率隨年級上升（七年級均約90%選譯臨床），服務型態及地點偏好高度都市化地區（68.5%期望在院轄市），醫院性質的工作（公立醫院51.5%私立醫院27.4%），此二方面的集中趨勢台大又較高醫顯著，期望收入平均（對數）每月新台幣8.30（標準差2.14）萬元。科別選擇偏好傳統已認定之分科，新興分科尤其走幕後工作，如麻醉、病理等乏人問津，但家庭醫學則已開始受到重視。
6．初步及穩定專業生涯，期望服務地點及出國的期望程度，可用校別、年級、家庭及個人基本特徵、習醫過程的生活與適應及價值觀念與態度之諸變項加以預測。本研究的結果，和國內外許多學者的研究結果相似，顯示了醫學教育的種種問題，於此，吾人建議：
1．醫學教育，甚至整體教育應有全盤的檢討與改進，宜著重創造力的培養、人道精神的發掦及團隊合作的訓練，尋求觀念上、方向上、實際教育工作及出路安排上的突破與創新。
2．多方探討、研究、評價、考核，擴展至各相關醫療保健人力訓練計劃。

關鍵字

醫學生 ； 社會化

並列摘要

In an effort to understand the process of socialization of medical students and factors affecting it, medical students of 1st, 4th, and 7th grade of National Taiwan University Medical College (NTUMC) and Private Koushiung Medical College (KMC) were investigated. Five aspects of this investigation are (l) Institutional characteristics of the schools, (2) Familial and personal characteristics, (3) Life style and way of adaptation during course taking, (4) Values and attitudes toward medicine, and (5) Professional carrer expectations.
The results are summerized as followings
1. It is lack of necessary training on social sciences within medical school, as well as useful education on humanism. The medical education has too much emphasis on high technology and sophiscate instruments, students’ achievements and developments are limited within highly specialized teaching hospital, especially at NTUMC. These are all the factors which hampers the medical students to become physicians who take care of ”human ” patients.
2. The majority of medical students are male (88.4%) on sex, and Taiwanese (70.0%) on domicile. In addition, most of them came from families with high social class, eg. 44% of them were born in urban area (provincial city and above); 19.0% and 28.0% of their families are level Ⅰand Ⅱ in socio-economic status (SES), respectively; 46.7% of them have at least one physician among their familial members. These characteristics indicate that medical students have quite a large social distance from ordinary patients.
In order to enter medical schools, the medical students experienced very tuft competetion and screening. 40.0 % of them graduated from the ”first class high schools (the best boy or girls' high schools), 71.7% had attended supplementary schools. 55.3% had taken at least twice entrance examinations. This tendency is more prominent at NTUMC.
3. Medical students' self perceived interpersonal relationships are overall not too bad. However, regarding stress adaptation and leisure activity, there are some problems.. The main source of stress among junior students are that of personality development and school life adaptation, and those problems among senior students are mainly career selections. The ways of adaptation are mainly by ones' self, secondly, consulting with close friends and family members, or teachers and senior peers. They seldom hold formal discussions or attended seminars of this sort in the class. In overall, the life style and the way of adaptation of KMC students are healthier than that of thieir NTUMC peers.
4. Personal expectations are toward more practical rather than idealism while getting senior. However, the main expectations reported are still to save people and to serve the society (87.5%), to acquire academic achievements (68.1%), and to have stable life (58.6%). Comparing with students of KMC, those of NTUMC have lessened criteria on what are bads of physicians. Regarding Physicians' social roles, most medical students prefer traditionally recognized ones, but senior students are more willing to parcitipate societal activities. 97.6% of them recognize the necessity of team-work in medical care, and 44.4% of them regard that the leaders of the team need not to be physicians. The average amount of social science knowlege of an ideal physician is 39.1±12.0%.
5. 80.8% and 80.0% of them, chose to be a clinician at the beginning of their career, and the final goal, respectively. And this rate become higher while getting senior. Regarding working locality, most medical students prefer highly urbanized areas and to practice in large hospitals-68.5% wish to work in National metropolitan area, 51.5% prefer public hospitals and 27.4% private hospitals. The tendency is more prominant at NTUMC. Average expected income is NT$83,000 ±21,400 per month. Medical students prefer traditionally recognized specialties. New specialties, ”especially those behind-the-scenes” departments, e.g. anesthesia and pathology, are still far from popular. However, more and more students, are paying attention to family medicine.
6. By multivariet analyses, we find that the beginning and final career choice, expected wora place and expectations for going abroad can significantly be predicted by variables such as school, grade, familial and personal basic characteristics, life adaptation during learning process, and values and attitudes.
The result of this study is similar with that of many others, and many problems are revealed. Accordingly, we would like to suggest
1. We should review the entire medical and overall education system and necessary improvements must be carried out accodingly.
The medical education system must pay more attention to develop the ability of creativeness, the knowledge of humanism, and the concept of team-work, therefore, breakthrough and innovation on the concept, orientation, and practice as well as the career development can be made.
2. Much more and better researches must be done on this issue, and similar studies must be expanded to other medical related training programs.

並列關鍵字

Medical students ； Socialization