醫師的誕生---實習醫師社會化過程之質性研究

Birth of the Doctor:A Qualitative Study of Medical Socialization on Interns.

王玫玉(Mei-Yu Wang)

指導教授 ： 劉仲冬

臺北醫學大學/醫學院/醫學科學研究所/碩士(2002年)

摘要

「實習」是成就一位醫師的重要階段。對實習醫師而言，無疑是個挑戰及被要求成為一位醫師的時期，在歷經長期的學生狀態後，突然被賦與「醫師」的主要角色及責任，在這一年的臨床實習，對於身分認同及角色轉變有什麼樣的看法，經由此一動態的學習過程，其親身經驗及主觀感受又是如何？這些問題涉及醫師的社會化過程及日後的醫療態度。本研究目的在藉由實習醫師之臨床實習經驗，解析醫師社會化過程之文化意義。應用質性研究之深度訪談及文獻探討收集資料。在正式研究前，先進行為期將近四個半月之前導性研究，依據先前之前導性研究修正，集中問題焦點，由民國90年6月1日至91年5月底止，進行為期一年之正式研究，包含先前之前導性研究，共訪談10位實習醫師，每次至少一個小時之訪談，將所獲得之資料整合加以分析，對此過程做全面的探索性研究，希望能得到更深度、豐富的訊息。研究結果發現，在醫療文化運作下，實習醫師之臨床學習經驗是一個兼具主動與被動的雙向過程。在學習過程中，逐漸接受所參與的醫療文化定義之規範與角色，經由不斷的修正，內化，建立屬於醫療專業的自我價值觀與態度。其中，更對醫療文化定義之醫師角色典範重新賦與新義，不再以完美形象造醫師，將醫師的角色典範視為一拆解與重塑的歷程，經由拼貼而成的醫師形象。 透過本土化實習醫師之臨床生活經驗為角度分析，將有助於醫學教育與臨床指導者更了解實習醫師的感受與想法，能對醫師養成教育之研議提供一個參考，讓實習醫師的主觀經驗不再被消音。 關鍵字：實習醫師、臨床實習、社會化過程、前導性研究、質性研究、 探索性研究、內化、角色典範

關鍵字

實習醫師 ； 臨床實習 ； 社會化過程 ； 前導性研究 ； 質性研究 ； 探索性研究 ； 內化 ； 角色典範

並列摘要

Internship is an important stage for interns to become doctors. For interns, it is undoubtedly a period full of challenges and they are required to behave like doctors. After being a student for a long time, an intern is suddenly asked to assume the responsibility and role of a doctor. What is an intern’s perception toward his/her identity and role change during the one-year internship? In addition, what is an intern’s experience and subjective perceptions during the dynamic learning? All of those problems would involve the socialization and medical attitudes of a doctor. The purpose of this study was to analyze the cultural meaning of a doctor’s socialization by the clinical experience of an intern. We performed a qualitative analysis about the content of interviews and explored the literatures to collect data. Before the formal research, we had conducted a four and half a months’ pilot study, which was revised according to the previous pilot studies and focused our attention on specific problems. From June 1, 2001 to the end of May, 2002, we conducted a one-year formal research to interview 10 interns, including those in the pilot study. Each interview lasted at least one hour. All the information was integrated and analyzed and the whole process was explored completely. We hope to get more thorough and informative data. We found that under the medical culture, the clinical learning of an intern is a two-way subjective and objective process. During the learning, interns would gradually accept the disciplines and roles that are defined by the medical culture they participated. With continuous modification and internalization, they built their own self-value and attitudes toward medical professionals. Above all, they redefined a doctor’s role model defined by the medical culture, and no more perfect image was created. They viewed the doctor’s role model as a process of taking apart and rebuilding, and then patched the image of doctors again. Through the analysis of local intern’s clinical experiences, we hope to help the improvement of medical education and clinical teachers can realize more about what the interns’ perceptions are. Also, we hope to provide guidelines to the professional development of a doctor, and not to bury the subjective perceptions and thoughts of an intern. Key words : interns, clinical practice, socialization process,pilot study,qualitative study, exploratory study, internalization , role model

並列關鍵字

interns ； clinical practice ； socialization process ； pilot study ； qualitative study ； exploratory study ； internalization ； role model

參考文獻

賴其萬(民89)。Karl Menninger對「從醫者的心理因素」所作之探討。 當代醫學27(6)，P.80-3。

宋瑞樓(民80)。醫師教育。當代醫學18(5)，P.436-41。

劉仲冬(民73)。當前醫學教育的危機。當代醫學11(5)，P.389-91。

施育芳(民88)。醫學教育與國小師資培育實習制度之比較研究。 國北師國民教育研究所碩士論文。 高熏芳、林盈助、王向葵譯(民90)。質化研究設計:一種互動取向的方法。 台北:心理出版社。 高美英、呂碧鴻、李明濱、王維典(民89)。醫學生的專科偏好與相關因素探討。醫學教育4(1)，P.23-37。

楊培銘(民90)。理想的臨床教學能在台灣實現嗎？醫學教育5(4)，P.271-272。