本研究採用質性研究之深度訪談法,以某教學醫院之實習醫師為研究對象,收集實習醫師在實習過程中對醫病互動之體察與經驗,以瞭解實習醫師與病人、家屬互動之現況與限制,及實習醫師對醫病互動關係與醫師角色之詮釋。共完成十一位實習醫師訪談。 研究結果發現,實習醫師的家庭背景呈現相當高的同質性,成長過程與求學歷程都相當順遂,同時,從實習醫師對臨床醫病互動關係之體察中發現,醫師仍是醫病互動關係中的主導者,且實習醫師對醫療爭議事件抱持著相當高的恐懼。而有限的生活經歷、缺乏社會技巧的訓練,在組織中不明確的角色定位,以及專業同儕較少給予支持指導等,是造成其與病人互動限制的原因。因此,研究者建議在訓練過程中,應增加人文課程與社會技巧等助人專業訓練,加強臨床訓練課程之規劃,並建立師生研討之機制,以提升實習醫師醫病互動之知能。同時,邀請不同專業與病人參與醫病教育,可擴展實習醫師對醫病互動之視野,以及用不同的觀點來瞭解人。而研究亦發現,實習醫師個人或親友的生病經驗,以及臨床老師的示範與對醫病互動之觀點,對實習醫師之醫病互動有重要影響,人文課程的設置與提供臨床老師教學之進修課程,都有利臨床醫病互動教育之推行。 而臨床醫學教育深受醫療環境生態與社會大眾觀念之影響,因此要培育符合社會期待之醫師,為實習醫師營造友善的學習環境,必須同時改善醫療環境、建立社會大眾正確之觀念,並配合醫學教育之改革,才能培育出符合社會期待之醫師人才。
This study data was collected by in-depth interview from the interns of the teaching hospital in Taiwan. It’s purposes are to understand the experiences of interns’ doctor-patient interaction and their perceptions of doctor-patient relationship. Finally, eleven interns were interviewed. The result revealed that interns have analogous family background and educational formation. From interns’ experiences, the researcher found that doctor still dominate the way of doctor-patient interaction, and interns have a fear of medical malpractice. And limited life experiences, lack of training in social skills, the intern’s ambiguous role in the medical setting and the absence of support from clinical teachers affect the relationship between intern and patients, especially in restricting intern-patient interaction. Well planned clinical training program, increasing discussion with supervisors and helping professional training program would be helpful. In addition, inviting other specialists to join the doctor training program, such as social worker and psychologist, would give interns a different perspective on understanding human being. Observing demonstration by clinical teachers and having experiences of illness themselves can also help interns learn how to better interact with patients. Furthermore, medical humanity curriculum and in-service training on how to teach would promote clinical education.