複雜系統下的醫學教育：由解構社會脈絡到共構醫學知識的問題導向學習課程

當代醫療已不再是醫者在上的主權模式，病患是完全參與者，並與醫療人員一起討論和控制自己的疾病，所以醫療人員在提供醫學處置之外，還必須瞭解病患所沉浸的社會脈絡，才能協助病患一起做出最佳的醫療決策。因此，本研究由複雜理論的視角，以醫療矯正鞋墊為課程主題，解構的鞋墊社會學脈絡與醫學專業知識為基礎，重建一個融入鞋墊科技醫療與社會思維的問題導向學習課程，期待能提升醫療照護專業學生發展以使用者為中心的臨床技術能力。研究方法為透過行動者網絡理論，與相關人員深度訪談，以瞭解鞋墊發展的脈絡。繼而由內容分析法形成鞋墊STS課程的重要構念，編撰臨床問題導向學習教案之文本，然後提供給學生進行6週的問題導向學習 (Problem-Based Learning, PBL)小組討論，並透過設計鞋墊衛教單，檢視學生學習成效。結果發現，由學生課後分享單解析，發現對於課程滿意度甚高。而對學生在PBL前、後所作的「鞋墊衛教單」作業中所含的知識結構分析之結果顯示，課程前所含醫學專業知識與產品資訊較多，但課程後則可發現突現出了比例甚高的使用者指引、安全注意事項與關心語等多元且分層的概念。因此，可推論以科技醫療與社會思維為基礎，解構社會脈絡而建構的問題導向學習課程，對於培育醫學專業發展更為全面而具推廣性。

關鍵字

行動者網絡理論；問題導向學習；鞋墊；複雜理論；醫療科技社會

並列摘要

Patients have been the complete participants with health care professionals to discuss and control their diseases, and health professionals do not always have the authority in the doctor-patient relationship in modern medicine. Therefore, health professionals need to provide the interventions and still need to recognize the social context of the patients, and then cooperate with them to make a better medical decision. Thus, the aims of the study were from the perspective of complexity theory, taking the medical insole as the topic to deconstruct the social context and medical knowledge to be the basis, then reconstruct a problem-based learning (PBL) programs of insole with the aspects of science-technology-society to help the health professions students to develop the clinical competence of client-centered thinking. This study employed a mixed-methods research design as the research methodology. Firstly, we analyzed the actors and context of insoles through the actor-network theory. Secondly, the content analysis method was used to find out the core constructs to develop the PBL scenario. As the PBL scenario completed, 6 weeks PBL small group tutorials were brought to students, and students were asked to design the health educational sheets of insole before and after the PBL to present their learning achievements. The result showed that students were satisfied with the PBL programs. Then, after analyzing and comparing the health education sheets, more medical concepts were presented before PBL, however, more insole using instructions, safety precautions and concerned statement emerged, and the diversity of concepts was also found after PBL tutorials. Therefore, the study suggests that the PBL program developed from the science-technology-society to deconstruct the social context and reconstruct with the medical knowledge helped the students to enhance their clinical competencies and might be helpful to cultivate further health professionals.