台灣醫學生科別選擇因素- 以在醫學中心實習者為例

Exploring the prominent factors to career choice of medical students in Taiwan--who have their internship training at medical centers

陳宜成(Yi-Cheng Chen)

指導教授 ： 邱瓊萱

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2011年)

https://doi.org/10.6831/TMU.2011.00010

摘要

背景: 近年來台灣每年加入外科的醫師人力逐年下降，根據1998年張金堅等人之研究結果顯示，91%的受訪醫院外科住院醫師不足。依據統計，目前每位醫師只照顧605位民眾，優於政府於2000年所制定每位醫師照顧750位民眾之目標，據此顯示醫師人數足夠，而願意加入外科的醫師人力卻不足。

目的: 外科醫師人力失衡是國內外醫療界共同遭遇的現象，欲改善這問題，本研究需要探討現代醫學生選擇臨床科別的影響因素，再分析其避選外科之原因以提出解決之道。

方法: 本研究計劃於民國100年一月至四月，邀請有意願之台灣醫學中心及其教學醫院並調查其即將畢業七年級學生401人，並由文獻及專家意見整理所得之問卷以李克特式七分法調查學生選科因素與及選擇外科之傾向，並以開放式問題詢問其選擇科別與排序；進一步進行描述性統計與推論性統計探討，從而了解造成外科醫師人力失衡問題之原因並設法提出有效之建議改善方案。

結論: 依據研究結果了解臺灣醫學生選科時，比較因素間重要性後，其順序為：個人興趣、科別生活型態與科別特性（包含工作量與工作壓力）。若醫學生最後不選擇外科最可能原因排名依序為：生活品質、工作壓力與醫療風險。而有可能選外科的學生對外科工作環境最在意者為：對家庭生活的衝擊、薪資與工作的付出不符合、人力與值班多寡等問題。而改善下列問題可以依序提高醫學生選擇外科意願：專人處理醫療糾紛及法律問題、改善工作時間過長與減少值班。除了以上各選科因子，還須考慮其他控制變項：
一、女性確實會因為「興趣與實習經驗」因素而影響對外科的選擇意願。
二、父母最高學歷稍高之醫學生對生活品質傾向較強，而可能降低對選擇外科的傾向。
三、學生成績則左右本國醫學生選擇科別的能力，成績最佳者加入外科的可能性為最低。
四、同儕、伴侶與典範影響於醫學生選科過程扮演著重要角色，其中
1. 同儕意向主要朝向以生活品質導向之科別為主，對選外科有負面趨力。
2. 伴侶期望之科別主要以保守與避免醫療風險為前提，而排除了外科。
3. 典範影響則驅動醫學生實現個人理想及典範仿效，對加入傳統大科有鼓勵作用。
總結：本研究使我們清楚瞭解醫學生選擇外科之正向動機與負面因素，我們應設法加強正面因素的誘因並減低負面因子的影響，才能實現增進醫師新血回流外科的期望!

關鍵字

醫學生 ； 選科因素 ； 外科住院醫師缺乏

並列摘要

Background: The number of recruited residents in the fields of surgery is decreasing in recent years. According to Dr. Chang’s research conducted in 1998, 91% of the investigated hospitals suffered the shortage of the surgical resident. The 2009 statistics report shows that each physician in Taiwan is responsible for 605 citizens in average, while the governmental target set in 2000 is not to exceed 750 citizens for a physician’s responsibility. These results reveal that the manpower of the Taiwan physicians is sufficient, but the recruitment of the surgical residents is a problem.

Purpose: The shortage of the surgical physician is a common problem in most countries. This study is designed to propose solutions for this problem based on the analysis of the factors that effect medical graduates’ decision in specialization, as well as what makes medical students not to choose surgery as their career specialty.

Methods: This study gathered 401 questionnaires responsed by 7th grade medical students interning in the medical centers and the teaching hospitals from Jan. to Apr., 2011. The questionnaire was designed with 7-point Likert’s scales to investigate factors effecting specialization decision and with open-ended questions to investigate students’ preference in career specialty. Descriptive statistics and inferential statistics were further applied for the data analysis. The analysis results provide guidance of solutions to solve the imbalanced distribution of the physician specialty.

Conclusion: Based on the research findings, personal interest, lifestyle of different specialty and specialty characteristic (including work load and pressure) are the first 3 factors in priority order, while the factors causing the students not to choose surgery in priority order are life quality, working pressure, and malpractice risk. For students likely to be surgical physicians, their concerns over the working environment are impact to work-family balance, incompatible to wages and work loading, shortage of manpower on duty, and so on. The improvement in the following problems would increase medical students’ intension to choose surgery: special messenger dealing with medical disputes and legal problems, shortening working time to avoid overloading. In additionm to the above factors, the following control variables should be considered.
1. Females tend to be reluctant to choose surgery due to their personal interest and internship experience.
2. Medical students whose parents with higher education background expect higher life quality and therefore have low intention to choose surgery.
3. Academic performances play a key role among Taiwanese medical students. Better academic performance, lower intentions to choose surgery.
4. Peers, partners, and role models play important roles to influance medical students’ specialty decision.
(1) The main concern of career choice among students’ peers is work-life balance, and it causes that these medical students are ultimately less likely to choose surgery.
(2) Viewpoint of students’ partners would drive students to choose career in prevention from malpractice risk.
(3) Role models play a significant role to influence medical students to realize the personal interest and follow the example. This factor causes students tend to select popular specialty.

Summary: This study reveals both forward motives and negative factors effecting medical students to choose surgery as their specialty. To strengthen the incentives to the forward motives and minimize the influence of the negative factors therefore are solutions to realize the vision that medical students take surgery as the career objective.

並列關鍵字

medical student ； factors of career choice ； shortages in surgical residents

參考文獻

張金堅、陳炯年、朱樹勳（1998）。全民健保後外科醫師人力之調查與分析。醫學教育 2: 273-81。

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