輔仁大學醫學系實證醫學的教學

Teaching Evidence-based Medicine at Fu Jen Catholic University

邱浩彰(Hou-Chang Chiu) ； 葉建宏(Jiann-Horng Yeh) ； 陳彥正(Yen-Cheng Chen) ； 張志華(Chee-Fah Chong) ； 楊巧如(Chiau-Ru Yang)

《Journal of Medical Education》 11卷3期 (2007/09) Pp. 193-200

https://doi.org/10.6145/jme.200709_11(3).0002

摘要

實證醫學是一種有系統的資料搜尋、評估與使用，透過網際網路與電子資料庫的運用，醫師們可以快速的獲得大量的醫療資訊，並將其應用在日常診療工作中。輔仁大學醫學系在五年級下學期也推出一學分的必修課程，訓練學生實證醫學的技巧。這是一學分的必修課程，共20小時，前面9小時介紹實證醫學的導論及方法，證據等級介紹，與實證醫學相關的生物統計，如何評讀文獻等；接下來的9小時是分三次的實際操演，利用個案讓學生分組來找問題、查資料、資料評讀、結論及如何應用到臨床，同學藉由自己找尋的經驗再觀摩其他組的查詢過程，可增進查詢的功力，同時在各組的報告中，學生也學習如何達到實證醫學的概念。最後一次的上課再簡介臨床指引(clinical guideline)的概念、發展過程及醫療經濟學的概念，同時給同學們回饋，對於他們的心得，使用問題請同學評估課程的優缺點，期末考為網路線上考試，題目公佈於網站，三天內要根據所訂定之PICO問題查完資料再作報告，報告方式與實際操作的格式相同，雖然只是一個學分的課程，同學的反應相當良好。

關鍵字

實證醫學 ； 醫學教育

並列摘要

Patients often ask physicians to interpret and explain medical information that they have heard or read about elsewhere. Insurers also expect clinicians to know which diagnostic and/or treatment strategy is most cost effective. Furthermore, clinicians are often asked questions for which the answer is not readily available or frequently changes. In addition, the amount of medical information available is expanding exponentially and physicians must develop ways to become lifelong learners so that they can constantly adapt to, absorb and evaluate this new information. As a result, evidence-based medicine (EBM) has become a paradigm shift in the practice of medicine. It has been described as the ”conscientious, explicit and judicious use of the current best evidence when making decisions about the care of individual patients”. In the Medical School of Fu Jen Catholic University, EBM teaching was integrated as part of the undergraduate medical students' curriculum in order to enhance their competencies in the areas of self-directed learning, diagnostic decision making and therapeutic decision making. During the 20-hour EBM training course, students are instructed how to develop a clinical question; how to research available medical resources; how to critically appraise the validity of the retrieved sources, and how to apply this information to an individual patient. The training consists of 9-hr of lectures, 9-hr of hands-on practice, and 2-hrs of summary and feedback sessions. Finally, the course is concluded with an online EBM contest and the results are published on the school's webpage. In addition to critically appraising the evidence gained from systematic searching, EBM in practice requires an amalgamation and integration of everything students have learned thus far. Therefore, it uses a problem-solving approach that includes pathophysiology, pharmacology, history-taking skills, physical examination skills and the development of a differential list. While students need to rapidly search medical information and assess its quality, they must also learn to make decisions in the absence of good evidence. We believed that EBM, coupled with excellent communication skills, can be used to meet these challenges.

並列關鍵字

evidence-based medicine ； EBM

參考文獻

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