第二年實習醫師對“教學門診”制度之需求

醫療環境變遷使醫師需於門診中完成診療及治療的比例漸高，但因其與住院、會診有些不同，且原本就具有多變、無法預測、直接及缺乏連續性的特性，因此如何能讓醫學生在參與門診醫療時，學習診療病人所需的技能及知識，為日後生涯預做準備，是醫師養成教育中很重要的一部份。本研究目的即是針對實習醫師進行評量，以暸解其對教學門診內容的需求與建議，為未來修正制度提供重要參考依據。本研究以某醫學中心全體第二年實習醫生共 87人為研究對象.問卷內容概分為：一、個人基本資料及曾參與的教學門診科別；二、選出個人印象最好的科別及老師，並詢問「好」的原因為何；三、對教學門診制度及教學目標的需求等。問卷共發出82份，回收80份，回收率為97.6%。學生覺得教學門診好的原因中，有87.2%是因為指導醫師有教學熱忱，73.1%是老師表達能力佳，認為教學內容適中者佔66.7%; 教學門診不好科別其原因依序為：教學熱忱不夠(59.6%)、沒有運用並教導相關之醫療設備或儀器之使用(44.2%)及學生自評臨床技能不足(26.9%)等三項。另學生建議第一年實習醫師參加教學門診的主要教學目標應為“身體檢查(82.5%)、病史詢問(80.0%)及溝通技巧(65.0%)；而第二年實習醫生則以用藥(70.0%)、X光判讀(66.3%)及實證醫學(63.8%)等三項較高。由研究可知，學生認為有效的教學門診中，老師應具有教學熱忱、表達能力、親切的態度、豐富的門診經驗、及會指導相關設備及儀器的使用方式。故未來開設教學門診時，如何選擇好的醫師或透是過適當的獎勵措施以提昇臨床醫師之教學熱忱，會影響學生的學習意顧及執行成效二而課程目標部份，學生認為教學門診仍應以教授傳統診斷技巧的病史詢問、身體檢查及溝通技能為主，特別是針對初到醫院的第一年實習醫師更須以此為教學重點，而對第二年的實習醫師則可增加專業能力較高的課程內容，以提昇其臨床工作能力。

關鍵字

教學門診；臨床醫學教育

並列摘要

The aims of the present study are to determine the factors that influence the implementation of ambulatory care education and establish a reference for future revision of the mode of education. Subjects of this study consisted of 87 second-yew intern physicians of a medical center in North-Taiwan. In order to understand the expectations of these intern physicians towards ambulatory care education, an evaluative questionnaire was drafted which included: 1) basic personal information and types (specializations) of ambulatory care education previously participated in, 2) an evaluation of specialization and teaching content, and 3) an investigation into the mode and objective of ambulatory care education. Of a total of 82 questionnaires, 80 were returned, giving a response rate of 97.6%. With regard to the reasons given by students for favoring a specific session, 87.2% of all students indicated that the main reason for their choice was the enthusiasm of the instructing physician, 73.1% said it was the physician’s ability to express himself, while 66.7% felt it was the teaching content. Reasons for specializations to not receive a good evaluation with regard to ambulatory care education, were the instructing physician not being enthusiastic enough (59.6%), the instructing physician not making use or giving instructions on the use of relevant medical instruments or equipment (44.2%), and students finding their clinical skills to be insufficient (26.9%). Students further indicated that, in case of first-year intern physicians, the main teaching objective of ambulatory care education should consist of the physical examination (82.5%), medical his- tow taking (80.0%) arid communication skills (65.0%). For the second year intern physicians, the most important areas were considered to be drug use (70.0%), analysis of X-ray films (66.3%) and evidence-based medicine (63.8%). (Full text in Chinese)