營養職類實習學生門診諮詢訓練導入問題導向學習之成效及滿意度變化

問題導向學習（problem-based learning, PBL）為以問題情境誘發自主學習及發展臨床推理之教學方法，而客觀結構式臨床測驗（objective structured clinical examination, OSCE）為用於訓練與評量臨床技術的方式。本研究目的在探討以米勒學習金字塔為原則，導入PBL於營養門診諮詢之課程模式，實施後以OSCE方式評估學生臨床問診、營養評估及營養諮詢之成效。比較2016及2017～2019年以PBL的滿意度問卷，探討PBL的導入對營養職類實習學生對課程安排、老師及同儕互動、增進臨床知識技能及應用在臨床照護上的滿意度。研究分析對象為2016～2019年南區某醫學中心接受營養門診諮詢的大專院校營養系學生共61位，在2016年接受OSCE前後測共12位，發現學生在接受PBL導入之訓練後，以成對樣本T檢定分析OSCE前後測成績之成效，結果發現飲食史詢問（11.5 ± 1.73 vs. 15.50 ± 1.88, p < 0.001）、營養評估及飲食設計（13.00 ± 2.95 vs. 15.33 ± 1.23, p = 0.015）及飲食衛教（8.25 ± 2.26 vs. 14.67 ± 2.15, p < 0.001）皆有顯著進步。將PBL導入營養諮詢門診教學後，比較2016和2017～2019年滿意度之變化，相較於2016年，2017～2019年超過半數項目的滿意度項目都提升，而在增進知識技能相關知識之感受分數提升最多，達到統計上邊緣之顯著（p=0.051）。本研究結果顯示，以米勒學習金字塔為原則導入PBL於營養門診諮詢之課程模式，對於學生問診、評估、營養衛教之臨床技能進步有助益。

關鍵字

問題導向學習；客觀結構式臨床測驗；實習學生；營養職類；學習成效

並列摘要

Problem-based learning (PBL) employs case discussion methods to facilitate learning and develop clinical reasoning skills. Objective structured clinical examination (OSCE) is a method of evaluating clinical competencies. The purpose of this study is to construct out-patient nutrition counseling training courses based on Miller's pyramid, introduce PBL into the course model, and apply OSCE to evaluate the effectiveness of such training for nutritional intern students after implementation. This study also compared the satisfaction of PBL in 2016 and the following years of 2017-2019 regarding curriculum arrangement, interaction with teachers and peers, improvement of clinical knowledge and skills, and application in clinical care. There were 61 nutritional intern students receiving training of nutrition counseling for outpatient in a medical center in southern Taiwan from 2016 to 2019. A total of 12 students received OSCE pre- and post-test in 2016. It was observed that pre- and post-test of OSCE scores of nutrition-related history inquiry (11.5 ± 1.73 vs. 15.50 ± 1.88, p < 0.001), nutrition assessment and diet design (13.00 ± 2.95 vs. 15.33 ± 1.23, p = 0.015) and nutrition counseling (8.25 ± 2.26 vs. 14.67 ± 2.15, p < 0.001) were all significantly improved based on paired t-test. After implementation of PBL into our training courses, changes in satisfaction scores of more than half of items between 2016 and 2017-2019 years were increased without significant difference. The greatest improvement was found in satisfaction scores of improvements of clinical knowledge and skill, reaching marginal significance (p = 0.051). The incorporation of PBL into nutrition counseling training courses constructed based on Miller's pyramid principles, was shown, in part, contribute to improvement of nutrition-related history inquiry.

並列關鍵字

problem-based learning ； OSCE ； interns ； nutrition and dietetics ； learning achievement

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