習醫造就：以「專業社會化」析論臨床環境對見習經驗之影響

本研究以「專業社會化」為研究視鏡，瞭解見習醫學生從課室學習走進臨床環境之經驗樣貌，旨在探討工作現場即學習環境造就習醫者之歷程。研究方法採質化導向的多階段設計，歷經兩年四階段，以國內、外臨床觀察紀錄、照像、44名半結構式深度訪談等取徑進行資料蒐集。研究發現：一、總體而言，工作環境給予見習生觀察和周邊參與式的實作機會；但面臨學習環境的轉變，見習生深受新學習模式、思考徑路、情緒適應的挑戰。二、見習階段即是建構專業認定的啟始，科別輪調課程提供機構式學習架構，專業互動是見習生獲得新知與演練技能的首要來源；因不能執行疾病治療，反而在醫病互動中更能純粹練習傾聽、同理、利他、耐心、陪伴、感同身受、接納等專業人文素養，成為體會專業人文精神之最佳時機，進而體悟全面的醫療專業。三、臨床主治醫「師」角色在於建構學習環境、示範醫療行為與決策，為醫病關係之楷模，從而影響見習生對醫者形象之建構。四、跨年級團隊學習、有功能的周邊參與、臨床主治醫師之帶領與教學規劃，以及醫病互動中演練專業人文素養，是臨床環境專業社會化，造就習醫者之要素。

關鍵字

工作環境學習；見習；專業社會化；質化；醫學人文

並列摘要

This study sheds light on clerks’ learning experiences of transitioning from classrooms to bedside through the lens of ＂professional socialization＂ with the purpose of illuminating how workplaces as learning environments have impacts on learning medicine. This study was entirely qualitative-driven and employed a 4-staged multi-design for data collection in two years. Approaches for data collection included bedside observations in multiple teaching hospitals in southern Taiwan and in California, taking photos of the artifacts and the contextualized interactions, and recruiting 44 students during clerkship years for semi-structured interviews either in one-on-one or in focus group formats. Results show that: 1. globally, the real workplaces provided clerks with opportunities for observation and peripheral participation. However, with the change of learning environments, clerks were challenged by new learning formats, thinking process and the emotional adaptation. 2. Clerkship itself was the initial step toward professionalism and identity. Grand rounds as a systemic approach of institutional affordances orchestrated learning. It was professional interactions from which clerks gained medical knowledge and skills. Clerkship programs provided exclusive opportunities for exercising medical humanities in the full potential, such as listening, empathy, altruism, patience, companionship, compassion, accepting and alike through interactions with patients. Consequently, they experienced full-fledged medical professionalism. 3. Attending physicians were the socialization agents. They structured bedside learning environments, demonstrated the practice of medicine and decision-making, and doctor-patient interactions, which consequently modeled the way toward professionalism and facilitated students’ identity formation. 4. Learning among colleagues with distinct statuses, peripheral but functional participation, attending physicians’ bedside teaching and arrangements, and trying-on behaviors of medical humanities through interactions with patients, were the defining factors of professionally socializing clerks to the medicine in workplace learning.