醫師自我認同發展之初探研究

醫師的養成過程當中會經歷不同的階段及環境，由於早期研究多著墨於醫學系學生在醫學院校或醫院實習遇到的困境，並未進一步了解醫學生在成為醫師後的心路歷程，是否會因為這段期間發生的事情而改變對於醫師的看法。因此本研究主旨在探討醫師自我認同之發展，包括自我認同、角色認同、專業認同及其他相關議題。本研究透過質性研究中的半結構式訪談方式，採用立意取樣與滾雪球的方法蒐集研究對象共計十人，皆為在醫院工作的男性主治醫師，每位對象訪問一次，訪談時間約30~90 分鐘，研究期間共計兩個月，並以開放性編碼的方式整理資料，將每份訪談稿做成逐字稿據以分析。研究結果在角色認同的構面有「規範」及「特性」兩個次構面，專業認同的構面則有「意識型態的認同」、「理念架構的認同」、「行為的認同」、「投入的認同」四個次構面。醫師在成長的過程當中會經歷不同的階段，透過學習、思考、實做等方式來了解醫師這個角色，當越了解醫師扮演的角色、專業知識技能越足夠，對醫師的認同發展會更趨完整及成熟。從醫師的發展階段可以看出外科系的醫師產生角色認同的時間較早，而專業認同的部分內外科醫師無明顯差異。除此之外醫療環境會對醫師角色認同發展產生影響，包括像對醫師的不尊敬、醫病關係變差、病人衛生教育的不足及投資報酬率不均等的問題，使醫師面臨了角色認同困境，從這些因素可以看出本研究部分醫師為了自己的生活品質，不得不在科別選擇上有所妥協，如同現在所謂「五大皆空」、「外科醫師出走」的現象，而醫師角色認同的困境會進一步改變醫師的專業認同。根據本研究的結果針對醫學教育、未來研究方向提出一些具體的建議，醫學教育方面如在醫學院校加強醫學人文教育、改善醫療環境對醫療人員造成的壓力、也在醫學繼續教育裡增加教導醫師認同的課程等；而未來研究方向可以針對不同年齡層與性別的醫師做比較。

關鍵字

角色認同；自我認同；專業認同；質性研究

並列摘要

Doctors play a very important role in the medical environment. In the process to become a physician, medical student must experience clerkship, internship, resident ship, and turn out to be the attending physician. The early researches focused on the dilemma of medical students in medical institutions or hospitals, rather than to mention the dynamic change of role identity while becoming a physician. This study , therefore, aims to examine the development of physician self identity, including self-identity, role identity, and professional identity. The study is designed as a qualitative design which adapts personal interview. The study samples include ten physicians who work in hospitals over ten years. All interviews are transcribed and further analyzed to develop codes and constructs. The results show there are two theoretical categories on role identity: conventional and idiosyncratic. There are four theoretical categories find on professional identity : identification of ideology , identification of conceptual framework, identification of behavior, and identification of commitment. Surgeons develop their role identity earlier than internal medicine physicians do in their professional stage. The study finds that physicians practice not only clinical skills but also communication skill through telling, thinking, observing, and most of all, adapting. Identity is not necessary coming along with mature medical knowledge and skill, but more on responding and adapting to social expectation as well the professional role. To help medical students to adapt their own identity, hospital administrators should enhance the friendly environment to physicians’ daily practices, and design a comprehensive training program to upgrade the doctor-patient relationship. According to the results of the study, we suggest that medical education should cover identity development process and ultimately assist medical students to meet the expectation of their own and society. Role model could help junior physicians to response challenges from medical practices and patients. Future research is recommended to compare the formation of self- identity between different age or gender groups.