透過醫療面談培育具有BPS專業能力的醫學生

Cultivating BPS Literate Medical Students Through Medical Interview

王維典

指導教授 ： 鄭湧涇

國立臺灣師範大學/理學院/生物學系/博士(2002年)

摘要

生物、心理、社會（Bio-Psycho-Social, BPS）專業能力是醫療面談成功的要件，因此，著者進行規劃，透過醫療面談培育具有BPS專業能力的醫學生。此規劃連結教、學與評量同步進行，主要包括下列四項內容：(1) 建構論學習方法 (2) 四階段專業培育方案 (3) BPS專業能力基準 (4) 以學習歷程檔案瞭解醫學生學習改進情形及進行BPS專業能力的評量。著者從實境觀察、醫學生BPS學習日記及師生面談中蒐集有相關證據支持的BPS實作能力相關項目，再經過修訂之大慧調查法建立BPS醫療面談基準。著者開發出一系列的提示工具，包括醫療面談學習流程圖、面談資料記錄表、五種學習歷程檔案記錄卡，及有關醫療面談技巧與透過BPS臨床考量之提示問題組，協助醫學生進行鷹架學習，著者亦發展出一系列的表格、認知圖範例，評分準則供醫學生參考使用，以利學習記錄並提供具體的學習標準。醫學生使用面談資料記錄表蒐集臨床資料，以認知圖探討臨床問題在BPS層面上的臨床意義，再將病人之BPS問題整理列表，以利臨床診斷。BPS能力標準及範例以書面方式明白列出，以利醫學生學習及自我觀察學習改變情形與成就。本研究以在台大醫院家庭醫學部接受四週臨床醫學訓練之30名醫學生為研究對象，生手醫學生經由課堂講述、門診跟診、與標準化病人演練（定錨）及與真實病人演練（鷹架）等過程進行學習。教、學與評量策略包括課堂講述、媒體學習、定錨學習、鷹架學習及學習歷程檔案的評量。醫學生以附加價值法蒐集相關證據，證明持續具有符合實作基準的能力。學習歷程檔案所包含的證據要能夠顯示醫學生所獲得的能力及獲得能力過程中的成長經過，附加價值法的目的在促進醫學生對自我及同儕的評量、建立學習信心及進行主動學習。研究結果顯示此培育方案可以發展BPS專業能力、證實醫學生的BPS專業能力及改進相關的教學與學習。

關鍵字

BPS專業能力 ； 醫療面談 ； 四階段BPS醫師培育方案 ； 學習歷程檔案

並列摘要

Bio-psycho-social (BPS) literacy is for achieving successful medical interviews. The researcher has, therefore, developed a program for training medical students to cultivate BPS capabilities through medical interviews. The program consists of the following components, which link teaching, learning, and evaluation. (1) A constructivist learning method (2) A four-stage professional development (3) A set of performance criteria for BPS capabilities (4) Portfolio based evaluation on BPS capabilities and students growth. A set of performance criteria for BPS capabilities was collected from evidence relevant to criteria from real context observations, BPS medical students’ journals, and teacher-student interviews. Then the criteria were established using a modified Delphi technique. The researcher developed a set of cues, such as medical interview diagram, an interview organizer, five kinds of record cards, and prompt questions for interviewing skills, content and BPS problems to scaffold students’ learning. The researcher also developed a set of sample forms, sample cognitive maps, and rubrics for students to based on and aid in record keeping, allowing them and researcher to understand performance standards expected. Students used the medical interview organizer to collect information and cognitive mapping to help determine the relationship among the information obtained in BPS dimensions, thus achieving diagnosis outcome. Rubrics are explicit guidelines for students to compare their progress against clearly understood standards. The subjects of the study were 30 medical students taking the four-week rotating clerkship at Department of family medicine, National Taiwan University Hospital. Novices were guided through the four-stage processes using workshop and anchored, scaffold, and independent practices. The teaching/learning/assessment strategies included lecturing, multimedia learning at the workshop, anchored with standard patients, scaffold with cues. In this portfolio assessment method, performance is assessed on the basis of BPS performance criteria; the student must gather evidence showing consistently meeting the criteria using value-added method. The principal researcher set out the purposes of portfolio that must provide evidence showing students’ BPS professional capabilities and changes during BPS professional development. This value-added method promotes students to assess themselves and their peers, while building self-confidence and willingness to take charge in their own learning. The results of this study show that the program can develop BPS professional capabilities, identify qualified BPS medical students, and improve instruction and learning.

並列關鍵字

BPS capabilities ； medical interview ； four-stage BPS medical doctor development program ； portfolio

參考文獻

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