某醫學中心教學門診計畫實施成效評估

Evaluation of an Ambulatory Care Teaching Program in a Medical Center

陳南松(Nan-Song Chen) ； 趙冠雅(Kuan-Ya Chao) ； 馮秀卿(Shiow-Ching Feng) ； 許惠恒(Wayne Huey-Herng Sheu) ； 蔡養德(Yang-Te Tsai) ； 邵克勇(Keh-Yuong Shaw)

《Journal of Medical Education》 7卷1期 (2003/03) Pp. 59-70

https://doi.org/10.6145/jme.200303_7(1).0008

摘要

衛生署為了提升教學醫院臨床教學品質，並確保醫療服務品質，加強醫師臨床訓練，於91年3月實施「教學門診暨教學住診補助計畫」提供每診次三千元的補助經費，希望以每診次限制病患人數之方式，提供給醫師良好的門診教學。本研究目的，為透過問卷調查方式，以中部某醫學中心在91年7、8月參與教學門診之主治醫師及學生為對象，探討教學門診實施之現況及實施教學門診後學生之教學滿意情形與學生自我評量結果，以做為日後實施教學門診之改進參考。結果發現，教學方式以老師同時看診及教學（55.9%）進行為主，其次為學生先診療佔23.7%，而病患來源由平常診約診（57.8%）為多，其次為初診自行前來佔25%；參加學生主要以實習醫師為多（49.2%），其次為見習醫師佔34.8%；學生較喜歡之教學門診進行方式為學生先診療與老師同時看診及教學「兩種方式並行」。而每診次實際的開診時間平均約為二小時（117.75分鐘），每診次實際的病人數平均為2.7人；實際參加之學生人數平均為3.55人。學生對指導醫師及學習自我評量均表現出極高的評比，且在「病史詢問」、「診斷」、「醫病溝通技巧指導」等項目受到學生高度的肯定。由研究結果可知，教學門診補助計畫的確大幅改善了門診教學方式，提升了門診教學之品質，學生及指導老師皆有極高的評價，因此希望衛生署教學門診補助計畫能持續推行，以期能確保臨床教學之教學品質。

關鍵字

教學門診 ； 臨床訓練 ； 實習醫師

並列摘要

In order to improve the quality of physician's clinical training and medical care, the Department of Health (DOH) has funded an ambulatory care teaching program since March 2002. The program pays NT$3000 for each teaching clinic as an incentive to the instructor and the patients are limited to 3 to 10 persons per clinic. The purpose of this study was to assess the quality of teaching by instructors and effectiveness of learning by students using questionaires from July to August, 2002. The students included clerks, interns and residents. The results would be used as a reference for the modification of the current ambulatory care teaching program. The data showed that in most cases (55.9%) the instructor makes the diagnosis while teaching the students at the same time. The second most common method of teaching (23.7%) is that the students make the diagnosis under the supervision of the instructor. The least frequent method of instruction (20.3%) is that the instructor and students make the diagnosis alternatively. About 57.8% patients were selected by the attending doctors from their general clinic. More interns (49.2%) than clerks and residents enrolled for the teaching clinics. With regard to the teaching model, students preferred to make the diagnosis first as well as learning by standing beside the instructor to watch and listen. The average time spent on each teaching clinic was approximately 2 hours (117.75 minutes) and the average patient number was 2.7 persons. The average number of students enrolled for each teaching clinic was 3.55. The students' evaluation of teaching quality and self-evaluation of their learning was very good. Among all the items evaluated, ”history taking”, ”disease diagnosis”, ”communication skill” were graded highest by the students. This study revealed that the overall level of success of the ambulatory care teaching program was excellent. The offering of a NT$3000 incentive and the limitation of the patient number at each teaching clinic were beneficial to ambulatory care teaching. In order to promote the quality of the ambulatory care teaching, we suggest the DOH continue funding this program in the future.

並列關鍵字

ambulatory care teaching ； clinical training ； interns

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