- 學位論文
台灣醫師對於「優質臨床教師需要的能力與特質」初探
Characters and Competencies of A Good Clinical Teacher - A Pilot to Investigate the Physicians' Perspectives in Taiwan
摘要
研究背景：台灣因應世界潮流，自1992年起開始全面性醫學教育改革；教育部於1999年成立醫學院評鑑委員會，各醫學院於其指導下陸續成立教師成長中心。2003年SARS風暴後，衛生署推動實施「教學醫院畢業後一般醫學訓練計畫」。在醫學教育改革的路途上，要提升學生素質必須先提昇教育訓練品質，所以培育優質臨床教師是當務之急。過去已有許多研究討論優質臨床教師需要的能力與特質，本研究想了解台灣的臨床醫師對於「優質的臨床教師需要的能力與特質」是如何看待。 研究目標：了解臨床醫師對於優質臨床教師需要的能力與特質之認知，並了解理想與現實之間的落差。 研究方法：以問卷調查法為主要研究工具，問卷之發展乃根據研究目的，參考國內外相關文獻找出基本元素，經三次焦點團體討論，使問卷具備專家效度（content validity index, CVI）達到0.8以上。此份問卷以Cronbach α係數進行問卷內部一致性信度分析，信度均屬良好（Cronbach α＞0.8）。以台灣三家醫學中心（X、Y、Z；X為某私立財團法人醫學中心，Y、Z為私立醫學院附設之醫學中心）的臨床醫師為研究對象，採匿名方式進行問卷調查。依「缺口理論改良方法（modified gap theory method）」運算落差權數（Gap Weight, GW），了解臨床醫師認為「優質的臨床教師的能力與特質」自我評估與重要性評比之間落差權數情形。資料分析採用SPSS 17.0統計軟體為本研究分析工具。 研究結果：本研究共回收409份有效問卷（XYZ醫學中心各為292、95、22份，），男醫師較多，年輕醫師較多，九成的年資為5至20年；資深醫師（主治醫師與總住院醫師）為58.9%，餘為資淺醫師（住院醫師）；多數醫師不具主管職(77.3%)；具醫學院教職者僅19.1%，其中六成為講師。本研究將優質的臨床教師應具備的能力與特質分為六個構面：教學理念與教學知識、教學技巧與方法、開發與使用教學資源、教學評量、教學態度與個人特質。每個構面所屬子題於自評與重要性評估之間均有顯著落差（p<.05）。臨床醫師認為「個人特質」構面的落差權數最大，「教學態度」構面的落差權數最小。資深醫師認為「個人特質」、「教學評量」、「開發與使用教學資源」落差權數較大，資淺醫師認為「個人特質」、「教學技巧與方法」、「開發與使用教學資源」為前三名；。資淺和資深醫師均認為「教學態度」構面落差權數最小。資淺醫師的落差權數普遍大於資深醫師。三家醫學中心、資淺和資深醫師、男女性別在六個構面各個子題落差權數同異互見，反映三家醫學中心的醫學教育發展的重心與方向互有差異。 結論與建議：「個人特質」構面落差權數最大，優質臨床醫師的最常反映於其個人的熱情、使命感等特質；不同教學醫院的醫師因背景、特色、與組織或文化不同，在各構面與各子題的落差權數同異互見，反映每一醫學中心之醫學教育自有其發展的特色。建議教師成長中心可參考落差權數大的項目，落實臨床醫師(學習者)之需求而據以提供適當之師培課程。
並列摘要
Background: Taiwan has started medical education revolution since 1992. Teachers are the key to success, so to nurture effective clinical teachers is the top priority. Many studies had done about the characters and competencies needed for effective clinical teachers. Objective: We wanted to investigate the physicians’ perspectives on “the characters and competencies needed for effective clinical teachers” in Taiwan. Methods and Materials: We conducted a questionnaire survey in 3 medial centers in Taiwan. We constructed the basic factors related to “characters and competencies needed for effective clinical teachers” through references first, and then we held 3 times of focus group discussion for developing the questionnaire（Content Validity Index>0.8）. We conducted a smaller pilot survey and Cronbach α was ＞0.8. We used “modified gap theory method” to calculate “gap weight, GW”. Different orders of GW in each item reflect the diversity among the physicians in different hospitals, seniority, and genders. Results: There are 6 domains about the characters and competencies needed for effective clinical teachers in our study: teaching concept and knowledge, teaching skills and methods, developing and using teaching resources, assessments, teaching attitudes, and personal characters. There was a significant gap between perception and significance of each item in each domain. The greatest GW was in “personal characters” domain, and the minimal one was in “teaching attitudes” domain. Junior doctors were with higher GW. Different orders of GW in each hospital, seniority, and gender were discovered. Conclusion and Suggestion: “personal characters” is the most important domain, and an effective clinical teacher mostly owns the characters of passion and mission to teach students. Different hospitals have diverse background, characters, organization and culture, so physicians in each hospital show some different and some similar opinions in different parts of domains and items. The diversity reflects different steps of medical education reform in different institutes, seniority and genders. CFD may take the higher GW items into account in their training programs to implement the concept of “learner-centered”.