教學醫院主治醫師過去臨床受教經驗、同儕學習與教育角色表現之關係研究

在教學醫院臨床醫學教育中主治醫師常常身兼臨床指導教師的教育身分，對各級臨床學員的教育成效有很大的影響。主治醫師除了透過教師培育課程來發展自己的教學能力外，也可能有其他的方式可以直接或間接的學習到教學的方法。對教師培育工作者而言，這些非正式課程的教師發展方式是非常值得探究的。本研究以社會學習理論為基礎，探討主治醫師教學能力的非正式學習途徑，包含了解教學醫院主治醫師在其過去臨床受教經驗、同儕學習與其身為臨床指導教師之教育角色表現的現況，並探討過去臨床受教經驗與教育角色表現、過去臨床受教經驗與同儕學習、同儕學習與教育角色表現之關係，並進一步探究過去臨床受教經驗在影響教學醫院主治醫師在教育角色表現的學習過程中的路徑關係。本研究以高雄市7所教學醫院與醫學中心之主治醫師為對象，採立意取樣，共計回收有效問卷364份，回收率為91%。研究工具「主治醫師教育角色表現與過去臨床受教經驗、同儕學習之相關性研究調查問卷」乃參考過去文獻中相關之量表及社會學習理論自行編製而成。工具共分成「主治醫師教育角色表現」、「過去臨床受教經驗」、「同儕學習」，「個人基本資料」等。後續採用描述性統計、單因子變異數、皮爾森績差相關、簡單迴歸及結構方程模式等分析方式將所得資料進行分析以驗證本研究之各項假設。所得到的研究結論如下：一、教學醫院主治醫師在教育角色表現的自我認知上程度良好，臨床教學與支持輔導層面會因為專科訓練年資、主治醫師年資、行政主管經歷而不同。臨床教學、支持輔導與工作督導三個角色表現層面及教育角色表現整體皆會因其在教育主管經歷不同及教學計畫負責人經歷不同而異。二、教學醫院主治醫師對過去臨床受教經驗中老師的教育角色表現評價良好，且各層面不會因為不同背景變項而異。三、教學醫院主治醫師同儕學習情形良好，教育交流層面會因為不同的醫療行政主管資歷及不同醫院教育行政主管資歷而不同。另外，同儕觀察、教育交流及同儕風氣等三個同儕學習層面的皆會因為教學計畫主持人經歷不同而有差異。四、過去臨床受教經驗較佳者在其教育角色表現上也會有較佳的表現。五、同儕間教育學習情形良好時，主治醫師教育角色表現也會有比較良好的情形。六、過去臨床受教經驗較佳時，同儕學習的情形也會比較好。七、主治醫師身為臨床學員時被教導的方式會影響其成為主治醫師時觀察學習同儕教學的方式與結果，也會進一步影響其成為臨床指導教師時教育能力的發展。根據研究結論與發現，做出以下之建議：一、教學醫院主治醫師應該注意自己工作中的教學模式可能會成為年輕學員建構教育相關價值觀及觀察模仿學習的來源，在教導一位年輕醫師時，也是在教導一位年輕的老師。二、對醫師所屬臨床單位主管的建議則是要重視組織文化對教學行為的影響，營造單位老師兼對於教育議題溝通的良好氛圍。三、醫院教師培育工作者應重視主治醫師教育角色表現的多元性，發掘教學優良的典範，並協助其他老師觀察學習。四、對於後續教師培育之相關研究，則應可以將研究工作再進一步修正調整，也應該要跨大研究範圍以提高抽樣之代表性。

關鍵字

教學醫院主治醫師；教育角色表現；過去臨床受教經驗；同儕學習

並列摘要

Attending physicians in teaching hospital play important roles in clinical medical education, especially in supervising clinical trainees for their learning in everyday practice. The development of an attending physician’s teaching ability is not yet well-studied, especially in those involving informal learnings. Based on Bandura’s social learning theory, we will examine the possible informal learning for clinical teaching ability of attending physician by observing others. This study aims to survey the condition of relationships among attending physician’s experience of being supervised as a clinical trainee and peer learning and the educational role enactment of attending physicians in teaching hospital. This study will also examine the possible model of observational learning that would contribute to the development of attending physician’s clinical teaching ability. The study subjects were attending physicians in 7 teaching hospitals in Kaohsiung city by convenience sampling. There are 364 valid questionnaires responded with a responding rate at 91%. Questionnaire named “The Questionnaire of the relationships among educational role enactment, past experiences been supervised and peer learning of attending physicians in teaching hospitals“ was developed according to previous studies and social learning theory and was revised with well reliability and validity. It contained “educational role enactment scale”, “past experiences been supervised scale” and “peer learning scale”. Data were analyzed with instruments including description statistics, one-way ANOVA, Pearson correlation, simple regression, and structural equation modeling (SEM) and then verified the research hypothesis. The conclusions of the study included: 1. The educational role enactment of attending physicians is well. “The year of starting specialty training”, “the year of becoming an attending physician”, and “being a medical administrator” would have impact on “Clinical teaching” and “Supportive facilitator”. “The experience of being an education administrator”, and “the experience of being a training project director” will have impact in all three aspects of attending physician’s education role enactment including “clinical teaching”, “supportive facilitator” and “a supervisor at work” 2. Attending physicians’ past experiences been supervised are generally well and background variables have no impact in different aspects. 3. The peer learning among attending physicians is well in all three dimensions. Both experiences in medical administration or educational administration would have impact on peer communication of education. On the other hand, the experience of being directors of education projects would have peer learning regarding to its three dimensions. 4. Attending physicians with better past experiences been supervised will have better enactment in educational roles. 5. Attending physicians with better condition of peer learning will have better enactment in educational roles. 6. Attending physicians with better past experiences been supervised will have better condition in peer learning. 7. Attending physician’s past experiences been supervised have indirect impact on educational role enactment throughout the path of its direct impact on peer learning, as well as peer learning’s direct impact on education role enactment. 1. Finally, according to the results, the researcher provides the following suggestions: Individual attending physician should address the important of self being a role model for younger doctors to learn not just professional knowledge and skill, but also behaviors in every educational encounters. Students would model not just the healthcare practice but also the teaching behaviors. 2. Leaders in each clinical teaching department should cultivate an open and safe culture for their attending physicians to observe and to share about what we think and what we do to make their teaching better. 3. Directors or staffs of faculty development should help attending physicians to find out good examples that other attending physician could observe and learn 4. The researcher should extend this research to teaching hospitals in other area