以認知圖提升醫學生問診能力

Using Cognitive Maps to Promote History-taking Skills of Medical Students

王維典(Wei-Dean Wang)

《Journal of Medical Education》 2卷3期 (1998/09) Pp. 264-272

https://doi.org/10.6145/jme.199809_2(3).0006

摘要

傳統的醫學教育對於臨床問診能力敎學的缺點，包括敎學時數少，及不能針對個人情況作個別評量及指導，醫學生在進行臨床問診時，面臨衆多不同的臨床狀況，往往不能充分發揮所學，使得問診效果大打折扣。而且因為缺乏可供自省、自我學習的有效工具，醫學生在畢業後，也無法藉由經驗累積，來熟練問診技巧的使用，保持問診品質。簡化、不完備的問診所造成的影響，不但問診及所包含的邏輯思考不能發揮應有的效果，醫病關係及醫療品質也會受到影響。本研究以認知圖、提問及標準病人回饋方式，敎導醫學生畫認知圖及使用認知圖，來發揮臨床問診的效果。藉由比較醫學生在學習使用此技巧前後，所作問診記錄的改進情形，發現認知圖的使用能協助醫學生在問診的內容、考量及周全度上有明顯的進步，且能具體表現醫學生問診時的思考邏輯。認知圖的使用可有效成為醫學生學習問診技巧的學習及評量工具。

關鍵字

問診技巧 ； 教學策略 ； 認知圖 ； 建構學習

並列摘要

Traditional medical teaching about how to take a clinical history has several shortcomings, which include a relatively short duration of instruction and lack of personal attention to individual student needs. As a result, medical students often find themselves unable to perform a thorough history taking in various clinical situations and are considered unable to perform the necessary logical calculations to prioritize patients' medical problems. This compromises the effectiveness of history taking and its contribution to the quality of patient care and jeopardizes the establishment of a good doctor patient relationship. The current educational programs also lack of the tools which students need to improve their history-taking skills and to maintain the quality of patient interaction. This study investigated whether the use of cognitive maps could promote history taking skills of medical students. Cognitive maps serve to externalize a person's concepts and improve his thinking. In this study, cognitive maps was used as a self-learning tool to facilitate the ability of clinical data collection and logical thinking in history taking. Basic principles of making cognitive maps were introduced to students. Students were found to have made important progress from discussion with instructors and from feedback from standardized patients. The study results indicated that by using cognitive maps, a medical student demonstrated progress in several areas of history taking from a standardized patient. He was able to more fully explore clinical information, make more relevant connections from this information, and was more thorough in making conclusions about the standardized patient's clinical problem. He was also more aware of the importance of good doctor patient interaction. Furthermore, through the use of concept maps, the student was able to demonstrate his thinking process in reaching conclusions about patients' medical problems. Based on these results, it is recommended that cognitive maps be used as a learning and assessment tool in teaching of history-taking skills for medical students. (Full Text in Chinese)

並列關鍵字

history-taking skills ； teaching strategy ； cognitive maps ； constructive learning