以Q方法探討醫學生選擇一般醫學訓練醫院之影響因素

Utilization of the Q-sort to explore the determining factors of selecting the post-graduate training hospitals among medical students

謝碧芬(Bi-Fen Hsieh)

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)

摘要

為因應醫療的變化，台灣於90年代開始進行醫學教改，畢業後一般醫學訓練計畫更為醫學教育史上劃時代的改革，衛生署與醫策會於2011年規劃推出「全一年期畢業後一般醫學訓練」。在此新制度下，醫學生需完成畢業後一般醫學訓練，始得接受專科訓練。此外，招收方式由以往各院自行辦理改為二階段選配制度，第一階段先進行不分科之一般醫學訓練醫院，第二階段再進行專科訓練醫院選配。以往醫學生畢業後選擇之醫院即為專科訓練醫院，在新制度的衝擊下，醫學生即會有兩次申請的過程，一為申請一般醫學訓練醫院，二為申請專科訓練。本研究之主要目的在於瞭解在新制度下，醫學生選擇訓練醫院的考量因素，及選擇因素重要性的程度？甚至在新制度的引導下，是否以未來專科發展為考量，進而挑選一般醫學訓練醫院。 基於上述之研究目的，本研究採用Q 方法論針對小樣本的醫學生進行其個人選擇訓練醫院的研究，Q方法論為探究受訪者主觀價值與態度的研究工具，採立意取樣選取國內30位醫學系、學士後醫學系之畢業生進行研究，由受訪者針對40個與選擇一般醫學訓練有關的陳述語句排列出重要與不重要的程度，再採用PQ method軟體將Q排列所得到的資料進行分析。 結果發現受訪者選擇一般醫學訓練醫院之因素可以被歸納為「重視工作報償」、「重視未來生涯發展」、「重視工作特性」、「重視學習與成長」等四種類型。藉由Q方法瞭解受訪者意見與態度，客觀地界定群體屬性。就本研究結論，期能作為未來醫學教育與醫師人力相關政策之參考，並提供後續研究者建議。

關鍵字

一年期醫師畢業後一般醫學訓練計畫 ； 訓練醫院 ； Q方法論

並列摘要

To meet the rapid innovation of medical service and demanding expectation from the society, a revolutionary medical education reform has been proposed since 2002. This general medical training program after graduation was epoch-making in the history of modern medical education in Taiwan. The Department of Health (DOH) and Taiwan Joint Commission on Hospital Accreditation (TJCHA) is about to implant one-year mandatory general medical training for medical graduates since 2011, the post-graduate year (PGY) program. Medical students are required to complete the PGY program before being qualified for their residency training for speciality. In this step, DOH employs a new system to match the positions in both PGY and residency programs in hospitals. In this newly developed system, the first step for medical students is to select the hospitals for the PGY program, and the second step is to choose the ones for residency training. The medical graduates will go through two stages of application and the process of matching, instead of one stage earlier. Moreover, the hospitals have to contemplate how to attract medical gradutes and be listed at the top priority so that they could recruit the best residents. Therefore, this thesis aims to study the important determining factors of choosing hospitals for PGY training program among medical students in this new system, and ultimately provide the result in the light of policy making in the teaching hospitals.
The thesis adopted Q method to identify the key factors of choosing PGY training hospitals in order to understand how medical students evaluate and priorize those factors. The Q method was a qualitative research tool to explore the subjective values and attitude of the interviewee. This study selected purposively 30 domestic 7-year medical students and post-bachelor medical students. They were asked to prioritize 40 statements of choosing PGY training hospitals according to its individual importance related to others. Then the results of the Q arrangement were analyzed through PQ method.
This study showed that the factors determining choices of PGY training hospitals can be grouped into four types; including the paycheck group, the future career development group, the job itself group, and emphasis on the opportunity of learning and growing group. The result showed what these four groups of medical students emphasize and their demographic characteristics, and ultimately provided as a reference in light of policies and human resources management to attract best talents.

並列關鍵字

training program of post-graduate year one ； training hospitals ； Q method

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