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Short-term Outcomes of a Near-full PBL Curriculum in a new Taiwan Medical School

在台灣一所新成立的醫學系幾近全面實施問題為基礎學習課程的短期成效

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摘要


「問題為基礎的學習」(PBL)採用成人學習原理而設計的學習,是醫學教育的一種重要改革,有越來越多的健康專業課程的設計採用此方法。然而實施PBL各學校、各科系的課程設計不一樣,是否可以在亞洲醫學院校全面實施PBL課程,尚需要更多的經驗與證據。輔仁大學醫學系是台灣第一所在三、四年級幾近全面實施PBL課程的學校(在台灣醫學系是七年的課程),他們自2002年實施以教案學習、小組討論為主的整合課程。本研究即是探討此一課程的短期成效。本研究試著從下列四點評估此一PBL課程的短期成效。(1)在進入PBL課程前後,學生在自我導向學習的改變(採用Guglielmino發展的自我學習傾向量表,SDLRS)。(2)以結構式質性訪談方式,了解PBL對學生在臨床年學習的影響。(3)學生在參加國家醫師執照考試的通過率。經過一年的PBL課程,輔大醫學系學生SDLRS的總分、及學習策略、自我評估分項的分數有明顯的進步,此一進步持續到四年級課程結束。進入臨床年後,學生認為PBL提升他們尋找資料、解決臨床問題的能力,對主動學習動機有幫助,且能運用所學的基礎醫學師知識去解釋臨床問題;另一方面,他們認為PBL課程所提供的學習廣度不夠,且無法給他們面對國家執照考試足夠的信心。前三屆的學生在參加國家醫師執照考試第一試時(考基礎醫學知識),其綠取率為全台灣醫學系最高;而第一屆及第二屆學生參加國考第二試(考臨床醫學知識)之通過率為100%。由輔大醫學系的經驗,顯示在亞洲醫學系幾近全面實施PBL課程是有可行的,可以改進學生自我導向學習的能力,可以學習到足夠的基礎醫學知識,且對臨床年臨床醫學知識的學習有正面效果。但仍需改變學生先學基礎醫學再學臨床醫學的觀念,並需再加強師資培育以增加小組討論的功效。

並列摘要


Problem-based learning (PBL), which incorporates principles of adult learning, is an important innovation in medical education. The use of PBL in health professional curricula is becoming more widespread. The curriculum design and the ways of implementing PBL are different among schools. More evidence is needed before a full PBL curriculum can be successfully implemented in an Asian medical school. Fu Jen Medical School is the first school in Taiwan to adopt a near-full PBL approach for the 3(superscript rd) and 4(superscript th) year curriculum (the medical education in Taiwan is mostly a 7-year undergraduate program). Fu Jen Medical School launched the interdisciplinary case-based, small group learning and integrated curriculum in 2002. This study investigated the short-term outcomes of this PBL curriculum, evaluated from several aspects. First, the self-directed learning readiness of the medical students before and after they entered the PBL curriculum was investigated using the Self-Directed Learning Readiness Scale (SDLRS). Second, semi-structured qualitative interviews were conducted with 5(superscript th) and 6(superscript th) year medical students and clinical instructors to understand the impact of PBL on the learning of clinical medicine. Finally, the passing rates in the Taiwan Medical Licensure Examination were compared with those of other medical schools in Taiwan. After 1 year of PBL, medical students at Fu Jen Medical School showed significant increases in the total SDLRS score, and in the subscores for learning strategy and self-assessment. These changes persisted until the end of 2 years of PBL. Students in their clinical years claimed that they were more active in learning, and had better learning skills and confidence in self-directed learning as compared with students from lecture-based curricula. PBL helps their clinical reasoning process, self-directed learning abilities and the use of knowledge in basic science to explain the clinical problem. On the other hand, the students thought that PBL had limited breadth and depth in clinical medicine and could not give them enough confidence in facing the national licensure examination. The initial batches of medical students (students from the first three cohorts) had the highest passing rate for Part 1 (basic sciences in medicine) and students from the first two cohorts had a 100% passing rate for Part 2 (clinical medicine) of the Taiwan Medical Licensure Examination. A near-full PBL curriculum in Asian medical schools is feasible and could encourage students to improve their self-directed learning abilities, learn adequate knowledge in basic sciences, and experience positive effects on learning clinical medicine. Better preparation of students for integrated learning of basic and clinical sciences are still needed, as is an emphasis on tutor training to improve the effectiveness of tutorial discussions.

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