以360度評核回饋結果分析一般醫學訓練學生對未來選擇科系之關聯

An Exploratory Relation Analysis of Physician’ 360 Degree Performance Appraisal Portfolio and the Subsequent Medical Specialty Choice

許志明(CHIH-MING HSU)

指導教授 ： 莊世杰

國立中正大學/管理學院/企業管理學系/碩士(2016年)

摘要

鑑於醫學進步及疾病越趨複雜化，避免過早專科化之醫學訓練使畢業後醫學生缺乏足夠一般醫學知能，行政院衛福部自2003年起陸續推動醫師畢業後一般醫學訓練計畫（Post-Graduated Year training, 簡稱PGY訓練），銜接學校教育與臨床服務，以提升醫療服務品質。衛福部並推動以360度 (包含同儕、護理人員、臨床教師、病人等對象)多面向評核機制以期瞭解學員學習發展情形，本研究目的是為了解學員將來選科與學習護照中360度評析向度的相關分析，探討影響學員選科之潛在特質或主要之影響因素，進而探討形成醫療人力分佈不均的原因。
本研究以近三年度(101-103年)至南部某區域教學醫院修習一年之PGY學員為主要研究對象，共計66位，樣本數為330份。資料蒐集之主要工具為PGY學員學習護照之360度評量表，包括臨床主治醫師、護理人員及同儕給學員的成績及評語。回收之評量表及學員選擇科別等資料，以SPSS 20.0版套裝軟體進行資料鍵入、資料整理以及統計分析等工作，並分別就敘述性統計及Logistic迴歸以1.意向科別、2.申請科別、3.結果科別、4.意向科別及結果科別一致性、5.申請科別和結果科別一致性、6.意向或申請科別一致性等六項科別選擇狀況為依變項進行資料統計分析。
研究結果顯示：1.護理人員之評核成績對於學員在選擇科別的各依變項上，皆呈顯著的正向影響。2.教師之評核成績對於學員選擇科別之意向及意向或申請科別一致性上，呈現顯著的正向影響。3.同儕的評核成績對於學員選擇科別之影響皆未達到顯著水準。
現狀360度回饋機制於本研究之研究結果顯示已有相當程度之影響，惟綜觀來說仍有進步的空間，針對評核表無法涵蓋之個人態度、看法以及各種社會環境因素對不同個體所產生選科態度之影響，未來可嘗試透過實際觀察法或進行深度訪談等質性研究方式作進一步的探討。

關鍵字

360度評量 ； PGY ； logistic迴歸

並列摘要

In light of the rapid advance of medical science and increasingly complexity of diseases, Ministry of Health and Welfare of Taiwan, R.O.C. initiated the post-graduate year 1 (PGY1) training program since 2003. This program aimed to enhance the medical knowledge and clinical skills of the graduated medical students in order to improve the quality of patient care. 360-degree feedback, which is introduced in this training program, is feedback that comes from colleague, nursing staffs, clinical teachers and patients. Choosing a specialty has always been a difficult process. Influences can be numerous including student-related factors and curriculum-related factors. However, the relationship between specialty choice and feedback is under explored. This study aimed to examine the relationship between 360-degree feedback and residents' subsequent specialty choices.
66 residents, who completed PGY1 training courses at a single hospital in southern Taiwan between 2012-2014 participated. Feedback and scores were given by clinical teachers, nursing staffs and peers. Scores of global rating, suggestions and comments from 360-degree feedback were collected (total 330 samples). The relationship between the scores of global rating and several variants were analyzed using binary regression logistic analysis. The variants include: (1) desired specialty; (2) applied specialty; (3) specialty which trainees enrolled; (4) consistency between desired specialty and applied specialty; (5) consistency between applied specialty enrolled specialty; and (6) consistency between desired specialty and enrolled specialty. The statistical software is SPSS Windows Version 20.0.
Logistic regression analysis showed that, the scores assessed by the clinical teachers and nursing staff, but not peers, significantly correlated with (1) the final specialty which trainees enrolled; and (2) the consistency between desired specialty and the specialty which trainees enrolled.
360-degree feedback has significant effect on the specialty choice, further study, using direct observation or interview, will be conducted to investigate if personal attitude, social and environmental factors will affect the specialty choices.

並列關鍵字

360-degree feedback ； post-graduate year ； logistic analysis

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