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  • 期刊

探討臨床病房對醫學院學生專業素養之教育養成方式及評估方法

The Formation and Evaluation of Professionalism in Medical College Students within Clinical Setting

摘要


背景:醫學專業素養(professionalism)亦稱為專業主義已經成為當代醫學教育中的重要的議題。已有許多研究指出,缺乏專業主義的醫學教育將使病人的權益遭到漠視。因此,醫學教育研究近來致力於開發專業精神教育及測量工具。目的:上述測量工具以醫學系學生與醫師為主要評量對象,測量著重於抽象概念為主之認知層面指標,缺乏測量具體醫學專業精神行為之指標,因此不易透過現行醫學專業精神之測量工具,辨識醫學生在臨床實習過程中,醫學專業精神實踐的狀況。方法:本研究選定某醫學中心之內科病房,由研究人員進入臨床醫學教育的田野中,進行每週一日,為期三個月之參與觀察。記錄實習醫學生在病房直接與非直接之各項醫療活動,並將這些記錄之活動依本研究合併ABIM Foundation, ACP-ASIM Foundation, and European Federation of Internal Medicine 與傳統中國醫學專業精神後所得之原則與實質內涵加以整理、分類。結果:我們從田野資料整理、分類、分析後初步發現,評量醫學生臨床實習醫學專業精神常用之工具,mini-CEX(mini-Clinical Evaluation Exercise,迷你臨床演練評量),聚焦於六種與直接臨床服務有關的行為指標。但是對於非直接臨床服務有關的測量指標則有所不足,諸如專業能力的提升、改善照護品質、改進照護管道、公平分配有限資源等。結論:本研究發現,病房裏的各種醫療活動潛藏一些不適用於上述四類非直接臨床服務有關的測量指標,值得採取觀察實習醫學生服務過程的方式,進行評量與回饋。(輔仁醫學期刊 2011;9(1):15-21)

並列摘要


Background:medical professionalism has become one of important issues in the field of contemporary medical education. There is widespread literature pointing out that patients’interests are neglected because a lack of medical professionalism. Recently, developing and applying tools for measuring medical professionalism is a trend on the rise. Purpose:thetools prescribed aim to measure medical students and physicians mainly. Indexes designed for measurement are focused on recognition of medical professionalism rather than on itsconcrete behaviors. It is not an easy way to apply those tools to identify practices of medicalprofessionalism in the internship process. Method:this research was carried out in an internalmedicine ward of one medical center, located in southern Taiwan. Researchers conducted fi eld observation in the ward once a week with about six-hour observation for three months. Theresearchers tried their best to take notes of what the interns provided during the course oftheir medical activities, both direct and indirect. The notes were sorted according to categoriesafter combining contents of medical professionalism defi ned in ABIM Foundation, ACP–ASIMFoundation, and European Federation of Internal Medicine, and Chinese medicine. Result:theprimal fi nding from the fi eld work is that indirect indexes of clinical services are needed despite the mini-CEX has included 6 direct indexes of clinical services. 4 commitments in medicalprofessionalism defi ned by ABIM Foundation, ACP–ASIM Foundation, and European Federation of Internal Medicine are involved in the indirect indexes, including commitment to professional competence, commitment to improving quality of care, commitment to improving access to care, and commitment to a just distribution of fi nite resources. Conclusion: it is worthy of note that observing intern’s service process involved with indirect clinical activities may help to carry outmore proper evaluation and feedback. (FJJM 2011; 9 (1): 15-21)

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