某教學醫院臨床技能中心之設置

Setting up Clinical Skill Center at a Teaching Hospital

呂志成(Chih-Cheng Lu)

指導教授 ： 蘇 喜教授

國立臺灣大學/公共衛生學院/醫療機構管理研究所/碩士(2007年)

https://doi.org/10.6342/NTU.2007.10554

摘要

「教學、研究、服務」是大學醫學中心的三大主要任務，其中又以提供醫學生的教學訓練活動為首要。大學醫學中心是醫師養成教育中臨床學習最主要的教學場所，各醫療部門每日進行著非常頻繁的教學訓練活動，醫學生從實際接觸病患中得到學習的機會，醫學生必需能在醫院逐漸累積經驗，學習足夠的醫學知識、臨床技能、態度與價值觀，以成為符合社會期待的稱職醫師。
在國外已經陸續採用標準化病人及客觀的評量方式來評估醫學生的臨床技能表現，目前在美國、加拿大與日本的國家醫師執照考試，都紛紛增加實際的臨床能力評量，作為取得醫師專業執照的考試制度。歐美日各大學醫學中心幾乎所有醫學生的學習成效評量，已經由單純之醫學知識的測驗轉移到臨床醫療技術表現的測驗。然而在國內國家醫師執照考試，仍偏重醫學專業知識，較忽略臨床實作技能及重要的醫學專業倫理和醫病關係技巧，且評量方式亦僅採用紙筆測驗，試題型式只有選擇題一種，較難取得多元資料據以判斷應考人之適任性1。因此，國內亟需設置臨床技能中心以執行醫學生之臨床技能訓練與測驗。
本文之主要目的在於探討醫學教育改革中，在推動基礎與臨床醫學整合課程的臨床技能學習時，如何設置一座符合國內醫學教育需求及國際標準的『臨床技能中心』，以有效進行臨床醫學教育訓練。有鑑於此，本文擇定積極推動臨床技能訓練的某教學醫院作為個案質性探討之對象，經由初、次級資料蒐集和相關文獻後，實地深入瞭解個案於民國93年配合醫學生臨床技能學習需要，由規劃、設計到與導入「臨床技能中心」之過程，及其使用後的經驗，來探討國內臨床技能中心在醫師養成教育中所扮演的角色與定位，進一步深入瞭解國內各機構設置臨床技能中心的概況，並提出結論和建議。
結 論
壹、注重臨床技能的評量，並擴及全面性醫療人員的技能提升
1. 認真落實檢測機制
2. 擴及其他醫事人員的技能檢測，全面性提升醫療品質
貳、設置專責單位，規劃完善的臨床技能訓練與評量的環境
1. 臨床技能中心規劃的主要內容
2. 設置專責的臨床技能中心，提供練習檢測場所
参、個案規劃的功能齊全、使用率高，值得借鏡
1. 基本設施及附屬設施功能齊全
2. 首創數位化教學影音安全監控系統，方便實用
3. 首創配置專任教學型主治醫師，協助教學課程規劃及發展
4. 導入初期使用率高
建 議
壹、專款補助臨床技能檢測經費
貳、分區成立臨床技能測驗中心，並發展國家級臨床技能訓練機構或場所
参、兩階段登記申請醫師執業執照
肆、發展亞洲模擬訓練中心之契機

關鍵字

教學醫院 ； 臨床能力 ； 臨床技能中心

並列摘要

A university-affiliated medical center is committed with 3 major missions, teaching, research, and service, of which the most important one is to provide medical students with training activities. As a medical center is the major place for the clinical training of medical doctors, there are very busy daily teaching activities in the various departments of a medical center. Through direct contacts with the patients, medical students learn and accumulate clinical experiences, clinical knowledge, clinical skills, and professional attitudes and ethics to become a competent doctor that meets the expectation of the society.
The use of standardized patients as an objective way for the evaluation of the clinical skills of medical students is gradually coming into fashion, as the national board examinations in the US, Canada, and Japan, have all included tests for clinical skills. Accordingly, in most medical centers in the US, Europe, and Japan, the evaluation of medical students has shifted its emphasis from medical knowledge to clinical skills. However, our national board examination is still tilted towards medical knowledge at the sacrifice of clinical skills, professional ethics, and the skills of patient-doctor relationships. Additionally, our examination is restricted to a multiple-choice format, making it very difficult to obtain multidimensional data for a complete evaluation of the examinee. Therefore, it is urgent for us to set up a clinical skill center for the training and evaluation of the clinical skills of our medical students.

This paper focuses on the establishment of a clinical skill center that meets international standards and answers the demands of our medical education system for effective clinical trainings, during a time when the medical system is reforming itself to integrate basic and clinical curriculum. The clinical skill center at teaching hospital, which has an active program for clinical skill training, was chosen for our study. An in-depth study, through primary and secondary data collection and literature analysis, was carried out on the clinical skill center, which was established in 2004 in response to the demands of the training of medical students. We covered the whole process from its conception, through various developments, into the actual existence. With actual experiences gained from this center, we try to clarify the role of a clinical skill center in the training of our medical doctors. Finally, after intensive surveys on the current status of the clinical skill centers in our country, we have the following conclusions and proposals:

Conclusions
First, focus on the evaluation of clinical skills, not only of medical doctors but also of all medical professionals, in order to
1) enforce the mechanism of evaluation and,
2) improve the quality of medical cares.

Second, charge a task force specifically for the set up of the clinical skill center that
1) have extensive covers of all relevant clinical skills, and
2) function as both a training center and and a test center

Third, model after the clinical skill center at the National Taiwan University Hospital, because it
1) is well-equipped with essential and accessory facilities
2) has a digitalized audio-visual system for safety monitor
3) employs full-time faculties for the teaching and curriculum development
4) has been highly demanded since the initial phase of its establishment

Proposals
1. There should be funds specific for the implementation of clinical skill tests
2. There should be a national center for clinical skill training, with regional sub-centers for clinical skill tests
3. The medical licensing process should be in 2 parts, knowledge and skill.
4. There is a good opportunity for the establishment of an Asian simulation training center

並列關鍵字

teaching hospital ； clinical competence ； clinical skill centre

參考文獻

8. 宋瑞樓：台灣醫學教育改進之我見。台北，Formosan J Med 2003；7:1；68-70。

10.魏璽倫: 多元入學醫學生之學習表現。醫學教育 2005:9(3):262-271。

13.劉敏，黃裕勝，劉克明：醫學生畢業時必備之基本臨床能力 醫學教育 2004；8（2）168-188。

21.劉克明，黃裕勝：應用英美醫學生臨床技能測驗模式落實台灣醫學生臨床技能測驗評估 醫學教育 ，2003；7（1）：15-21。

22.謝正源等：標準病人與醫學教育，醫學教育2004；8（3），243-254。