體驗式案例教學對醫學大學生學習興趣、同理心及醫病溝通能力之探討

Investigation of Medical Crisis Communication Teaching in Medical University Students' Learning Interests, Empathy, and Ability of Doctor-Patient Communication

姚惠忠(Hui-Chung Yao) ； 鄭立婷(Li-Ting Cheng)

《通識學刊：理念與實務》 11卷1期 (2023/03) Pp. 43-80

https://doi.org/10.6427/JGECP.202303_11(1).0002

摘要

醫病關係一直是醫療院所面對的嚴肅課題。醫病溝通課程對醫學大學的學生而言，重要性不言可喻。本研究探討體驗式案例教學對醫學大學生醫療危機溝通之學習興趣、同理心及醫病溝通能力之成效。以混合研究法選擇南部某醫學大學選修「醫療危機溝通」通識課程的48位學生為研究對象，透過量化分析與質性資料分析比對，研究發現體驗式案例教學在提高學習動機、理解力與課程認同方面成效，是值得採納的教學方式。透過生氣故事撰寫與分析，明顯促進設身處地的同理心態，且學生也自我期許未來到職場將更能發揮同理心。案例分析作業中提供輔助工具有助於學生的分析表現，且學生自評案例分析作業能有效縮短理論與實務之差距，從而提升醫病溝通能力。惟本研究只讓學生單面體驗病人或家屬的經歷與感受，為了更完整體驗醫病雙方心情，未來課程可請學生分別報告醫療人員與病患生氣的故事的案例，以期同學更能「理解」並「實踐」兩面俱呈的真實同理心。

關鍵字

同理心 ； 學習興趣 ； 醫病溝通能力 ； 醫療危機溝通 ； 體驗式案例教學

並列摘要

The patient-physician relationship is a significant issue that has been confronting the healthcare providers since the nature of meeting persons to provide the services forces physicians to bear the risks of malpractice in their practice. Accordingly, the motivation and purposes of the study focus on not only how to effectively promote medical students' learning interest, comprehension and acceptance but also fostering their empathy and competence of crisis communications in practice when making it one of general studies. Three research questions are proposed as follows. A. How have the medical students' learning interest and motivation, comprehension degree and acceptance to the curricular content altered by adopting the case method of instruction? B. How did the experiential irritating tale promote medical students' empathy? C. How did the experiential case analysis assignments advance medical students' competence of applying crisis communications to practice? The experiential classroom activity "What irritated you in the hospital" was a curricular scheme to facilitate empathy of medical students. Firstly, three as a group collected the experiences by their own recollection or interviews with their relatives concerning what scenario irritated them, compiled them as a written tale and identified the "irritating points" in the tale. Secondly, they were brought to deliberate which link in the process or what kind of reactions given by the healthcare professionals at the hospital probably irritated the patients or their relatives and thus to reflect the associated links and reactions in their future practice they ought to focus on. Thirdly, every group presented the report in three parts: what happened, irritating points and reflective remarks. Lastly, the lecturer reviewed the presentation and pinpointed how the irritating point was formed. Hopefully, this helped foster their conception and mindset of deliberation at the stance of the patients and their relatives. To urge medical students to apply what they have learnt to the real crisis cases, the classroom activity was done as follows. Firstly, three as a group had the discretion to pick a crisis case in the medicine, food or public health domains. Secondly, by using the analysis framework offered by the lecturer, each group was asked to analyze the followings: the whole story of the case, if the case was handled in compliance with the basics learnt, the crisis situation where the organization was at, the crisis communication strategy used thereby, if the situation and the strategy were compatible, etc., Lastly, the afterthought report on the case analysis was submitted. Hopefully, this helped enhance their competence of applying crisis communications. In addition, in pursuit of raising the applied analysis accuracy, the course edited a specific tool as the reference to medical students for use in terms of the required analysis specifics. To identify the degrees of medical students' learning interest and motivation, comprehension and acceptance as the three learning performance construes of the study, their corresponding scales were edited accordingly. To verify if the experiential assignments improved their empathy mindset, they finished the pretest at the beginning of the semester and the posttest after the experiential assignments completed. To verify if provision of the edited tool improved the analysis accuracy, the strategy and situation analysis accuracies of the analysis assignments submitted by two classes (in 108 and 109 school years) were compared. To verify if the case analysis assignments improved their competence of applying empathy, the full text of the afterthought reports submitted after the assignment completed applied to the qualitative analysis. The survey results are as follows. In terms of the learning interest and motivation, 88% agreed on their learning interest or motivation increased by the case instruction. In terms of the comprehension of the curricular content, 90.6% agreed on their comprehension enhanced by the case instruction. In terms of the case instruction, 92.4% conveyed their recognition and confirmation thereof. Notwithstanding, the further mediation analysis indicates that their learning interest and motivation cannot affect their acceptance directly since the former must affect the latter indirectly via their comprehension as the mediator. Such result proves the importance of how students comprehend the curricular content. Their improved acceptance of the curricular content can hardly be attained without their enhanced comprehension thereof although the course might be vibrant and fun the content wise. In other words, their comprehension of the curricular content is the key factor of how the case instruction worked. The empathy pretest and posttest results indicate the following findings. As it comes to perspective taking, emotional care and empathizing with others the three construes, only a significant difference in the "empathizing with others" pretest and posttest results appears; that is, the experiential assignments significantly improved their empathy the empathizing with others wise whereas their empathy the perspective taking and emotional care wise failed to improve too obviously. This might arise from the following. On one hand, as for the Likert 7-point scale, the scores achieving 6.23 and 6.45 in the first two construes pretest mean figures tend to be too high, making a significant difference caused by too slightly improving scores unlikely to be detected obviously. On the other hand, as for the empathizing with others construe, the pretest and posttest mean figures hiked from 3.88 to 4.52, showing that the experiential instruction drove the empathy degree from the mild-moderate to moderate-major trends. Such findings probably arise from medical students initially with higher empathy levels the perspective and emotional care wise but finding it very challenging to practice it, but the experiential assignments lower the challenging level and encourage them to practice empathy the perspective and emotional care wise at some point. The findings obtained on the basis of the textual analysis of the afterthought reports for further observations are as follows. Based on their reports, when practicing in the future, they would deliberate in the mutual stances, do perspective taking, avoid dissensions with empathy, feel for others, and be considerate of patients. According to the text, medical students' self-expectations and hopes depict that the irritating tales at the hospital help them spot the causes why the patients or their relatives got irritated, get compassionate with what happened thereto, and further reflect and come up with a solution to the adversities of the patients or their relatives improved by small measures from the hospital or healthcare professionals. Consequently, the experiential assignments help foster and improve empathy, proven to be a valid and attempt-worthy teaching design means. Besides, provision of the edited tool can not only effectively promote 15% of the analysis competence but also ensure the analysis accuracy achieving 75%, so the case analysis assignments do improve the application competence. According to the findings, the limitations on the study and the references to further studies are proposed as follows. First, the teaching assessment remarks show that medical students prefer the full-length case that depicts plural crisis communications principles, but it requires further studies to prove which works better to improve the learning interest and motivation, comprehension and curricular recognition effects as it comes to the full text and the summary of the case. Second, the irritating tales at the hospital merely display unilateral processes and sentiments of the patients or their relatives; therefore, for better savoring the patients' and physicians' sentiments, the future curricular scheme may invite medical students to present what irritates physicians and patients, respectively, which makes them more capable of understand and practice the authentic bilateral empathy. Third, as it comes to the case analysis assignments, provision of the edited tool not only effectively promoted 15% of the analysis competence but also ensured the analysis accuracy achieving 75%, but it can be improved or progressed; thence, it is essential to fabricate more tools and approaches of future teaching in order to help hike the analysis accuracy.

並列關鍵字

empathy ； learning interest ； doctor-patient communication ability ； medical crisis communication ； experiential case teaching

參考文獻

王全興（2016）。體驗式案例教學在教學上的應用。師友月刊，587，48-49．https://doi.org/10.6437/EM.201605_(587).0009 【Wang, Q. X. (2016). The application of experiential case teaching in teaching. The Education Bimonthly, 587, 48-49. https://doi.org/10.6437/EM.201605_(587).0009】

李欣欣（2016）。體驗式教學法於初級商務華語教學中的應用。臺灣華語教學研究，12，43-66。https://doi.org/10.29748/TJCSL.201606_(12).0003 【 Lee, H. H. (2016). Application of experiential learning model in fundamental business Chinese teaching. Taiwan Journal of Chinese as a Second Language, 12, 43-66. https://doi.org/10.29748/TJCSL.201606_(12).0003】

陳志洪、李佳穎、齊珮芸（2020）。擴增實境輔助拼圖學習系統對學習成效、學習動機與學習興趣之影響。教育傳播與科技研究，123，21-38。https://doi.org/10.6137/RECT.202008_(123).0002 【Chen. Z. H., Li, C. E., & Chi, P. Y. (2020). Effect of an augmented reality-based jigsaw learning system on learning effectiveness, learning motivation, and learning interest. Research of Educational Communications and Technology, 123, 21-38. https://doi.org/10.6137/RECT.202008_(123).0002】

許鎧麟（2020）。運用數位模擬教學技術於工程材料試驗課程之學習成效評估。工業科技教育學刊，13，18-29。https://doi.org/10.6306/JITE.202011_(13).0002 【Xu, K. L. (2020). The evaluation of the learning effectiveness on using digital game-based learning in engineering material experiment teaching. Journal of Industrial Technology Education, 13,18-29.】

馮丰儀（2012）。案例教學在大學專業倫理課程應用之探討—以教育行政倫理課程為例。慈濟大學教育研究學刊，8，1-30。https://doi.org/10.6754/TCUJ.201205.0001 【 Feng, F. Y. (2012). The application of case method in teaching professional ethics in the university- Using the educational administration ethics course as an example. Tzu-Chi University Journal of The Educational Research, 8, 1-30. https://doi.org/10.6754/TCUJ.201205.0001】