某醫學中心教學住診計劃實施成效探討

衛生署為了提升教學醫院臨床教學品質，於91年3月實施「教學門診曁教學住診補助計畫」，以期落實完整的臨床教育訓練。本研究目的為透過問卷調查方式，以中部某醫學中心在91年7月份參與該補助計畫床邊教學之主治醫師及學生為對象，每次教學後師生均需填寫評量問卷，探討床邊教學實施之狀況及實施床邊教學後指導醫師與學生之教學滿意情形與學生自我評量結果，做為日後實施床邊教學之改進參考，資料收集二週，共得教師記錄表141份，學生學習評量表295份。結果發現，床邊教學地點以病房為主佔86.3%；教師於床邊教學前之準備時間以30分鐘內為多，佔49.3%；其次為30分鐘至1小時佔30.0%，每診次實際參與學生數平均為3.27人，而老師與學生所認為每診次之合適學生數約3～4人，老師所認為合適之教學時間為34.92分鐘，而學生認為合適的教學時間平均為41.17分鐘（141.2%學生表示30分鐘內為合適之教學時間）；參與學生身份以住院醫師為最多佔35.9%，其次為實習醫師佔34.9%；學生科別分佈以外科系為最多佔54.2%，其次為內科系佔24.7%；對指導老師之教學評量與學生自我評量均呈現極高的評比，且在「診斷」、「鑑別診斷指導」及「病史詢問」等項目受到學生高度的肯定。本研究結果師生均呈現高度滿意，因此建議此補助計畫確應繼續推行。因該補助計畫為91年度開始實施，國內尚無針對該計畫進行相關之實施現況及實施滿意之研究，本研究醫院之實施經驗與實施成果，不僅可提供給實施教學門住診補助計畫之醫院參考，並可提供衛生署政策擬訂之參考，以期提供給學生更為完善且詳盡的臨床教學模式，並確保醫療服務品質。

關鍵字

床邊教學；臨床訓練；實習醫師

並列摘要

In order to improve the quality of physician’s clinical training and medical care, the Department of Health (DOH) has funded a bedside teaching program since March 2002. The purpose of this study was to assess the quality of teaching by instructors and effectiveness of learning by students using questionnaires. The students included clerks, interns and residents. A total of 141 copies of the instructor questionnaire and 295 copies of the student questionnaire were collected in mid-July of 2002. The data showed that the majority of teaching (86.3%) was carried out in wards. The average number of students enrolled for each teaching session was 3.27. The most suitable length of time for the bedside teaching was considered to be 34.9 minutes by the teachers, and 41.17 minutes by students. The majority of the students were residents (35.9%). The evaluation of the teaching quality and the effective-ness of learning by the students were fairly good. Among the items taught, “disease diagnosis”. “history taking”, and “differential diagnosis” were all highly graded by the students. Thus, this study revealed that, as a whole, the bedside teaching program was quite successful. Our study also showed a high level of satisfaction among both the instructors and students, so we suggest that this program should be continue in the future. This is the first report evaluating the educational outcomes of this program, which began in 2002. The experience obtained during this study and the results from this study can be used as a reference point not only by other hospitals, but also by the DOH.