敘事醫學應用於病歷記載之實作與成效：一個醫學中心復健醫學部的臨床教學經驗

The Outcome of Teaching and Writing in Clinical Medical Records by Using Narrative Medicine

張智雅(Chih-Ya Chang) ； 吳永燦(Yung-Tsan Wu) ； 李宗穎(Tsung-Ying Li) ； 蔣尚霖(Shang-Lin Chiang) ； 楚恆毅(Heng-Yi Chu) ； 呂佳蓁(Jia-Zhen Lu) ； 紀君函(Chun-Han Chi) ； 楊宛樺(Wan-Hua Yang) ； 張幸初(Shin-Tsu Chang)

《中榮醫教》 17期 (2015/07) Pp. 9-17

摘要

本研究探討應用「敘事醫學」〈narrative medicine〉的理念，讓實習醫學生將臨床經歷及觀察過程，記載於病歷，並評估實習醫學生六大核心能力養成和臨床病歷寫作的成效。以某醫學中心復健醫學部23位實習醫學生為研究對象。除傳統病歷書寫指導外，再授予敘事醫學概念及臨床應用做法。測量工具包含設計「病歷書寫納入敘事醫學」問卷調查。此問卷由四大部分組成，一、年級及性別，二、就問題的熟悉程度評分，三、評估是否推薦此作法及建議實施的時期，四、針對此做法之開放式建議及評論。所得資料以SPSS 20.0套裝軟體〈Paired Samplestatistics〉統計分析。結果顯示，採取敘事醫學作法，對於實習醫學生六大核心能力養成和英文病歷書寫程度，統計學上有顯著差異〈p ＜ 0.05〉。前測問卷中，47.8%實習醫學生認為敘事醫學在大學五年級〈見習時段〉推廣有較大成效，26.1%於一、二年級，13%於三、四年級和六、七年級〈實習時段〉。後測問卷中，仍有47.8%實習醫學生認為敘事醫學在大學五年級推廣有較大成效，26.1%於三、四年級，13%於大學一、二年級和六、七年級。前測時95.7%實習醫學生願意推薦敘事醫學給其他醫師，後測時則高達100%。本研究顯示實習醫學生至復健部學習，應用「敘事醫學」可提升實習醫學生六大核心能力之養成及英文病歷書寫程度。

關鍵字

敘事醫學 ； 復健 ； 醫學教育 ； 實習醫學生 ； 核心能力

並列摘要

Narrative medicine is a descriptive approach in patient care. This study aimed at teaching narrative medicine and evaluating the six core competencies and the effectiveness of medical writing ability for the intern doctors. We recruited 23 interns at Department of Physical Medicine and Rehabilitation in a medical center. In addition to teaching the guidance of the traditional medical records, we also introduced the concept of narrative medicine to perform clinical practice. Methods: A questionnaire was designed for evaluating the effectiveness of narrative medicine in medical records. The questionnaire consisted of three sections: the first was intended to elicit simple without individual character of the interns; the second asked interns to rate their performance of narrative medicine in clinical practice; the last focused on realization of the narrative medicine in teaching. Survey of clinical application of narrative medicine was assessed from their opinions. The SPSS 20.0 software package was used for data analysis. Results: The study showed significant statistical differences in interns' six core competencies and English writing ability of medical records(p ＜0.05, respectively). In the pre-questionnaire, 47.8% of interns considered that the best instructed grade for practicing narrative medicine was in fifth grade (clerkship); 26.1% suggested in first or second grade; 13% implied third or fourth year and internship. Post-questionnaire, 47.8% of interns still insisted that narrative medicine for clerk´s had greatest effectiveness; 26.1% in the third and fourth at the university; 13% suggested the first and second grade. They considered that narrative medicine had good learning effect in the third and fourth grades so the difference between of pre- and post-questionnaire implied that 13% of them shifted to 26.1%. In pre-questionnaire, 95.7% of interns would recommend the narrative medicine to other physicians. In the post-questionnaire, 100% of interns would like to endorse the narrative medicine to others. Conclusion: The application of narrative medicine might be able to enhance the medical interns' six core competencies.

並列關鍵字

narrative medicine ； rehabilitation ； medical education ； medical student ； core competencies