Title

以基層診所醫師擔任醫學生社區醫學課程教師之模式評估

Translated Titles

Feasibility Evaluation of a Curriculum Medicine Curriculum Employing Community-based Preceptorship

DOI

10.6200/TCMJ.2005.2.7.03

Authors

余儀呈(I-Chern Yu);黃信彰(Shinn-Jang Hwang);陳亮恭(Liang-Kung Chen);陳振文(Tzen-Wen Chen);陳震寰(Chen-Huan Chen);何橈通(Low-Tone Ho)

Key Words

基層診所 ; 社區醫學 ; 經驗學習理論 ; 醫學生 ; 教師 ; 問題導向學習 ; community medicine ; experiential learning theory ; medical students ; preceptor ; primary care clinics ; problem-based learning

PublicationName

北市醫學雜誌

Volume or Term/Year and Month of Publication

2卷7期(2005 / 07 / 01)

Page #

605 - 617

Content Language

繁體中文

Chinese Abstract

背景及目的:為了了解醫學系學生至社區診所觀摩學習之可行性,本研究探討社區診所基層醫師兼任執業教師的可行模式及讓醫學生從社區的層次認識真實的醫療狀況外,同時根據Kolb氏的「經驗學習理論」模式觀察學生之學習週期與學習型態。研究方法:整個計畫在醫學大學醫學教育之管理架構下,由醫學院家庭醫學科負責執行,並由醫學院之教學醫院某醫學中心家庭醫學部負責與社區診所醫師之協調聯繫。本研究遴選醫學中心鄰近社區的診所開業醫師共計十二位擔任社區執業教師,這些醫師於民國九十年九月至九十一年六月一學年度二學期中在其執業場所對醫學系四年級學生進行每週一次共十六週、每次三小時的教學。每次二至四名醫學生至一診所見習觀摩,學生以輪調方式分派至不同執業老師處見習,每處以兩次見習為一梯次,兩次內容分別以第一次診所學習觀摩(選擇病患會談、觀察醫師執業內容及如何處置病患、就學習綱領某一焦點主題提出討論等方式)及第二次追蹤輔導及提報告討論為原則。結果:依社區執業教師教學意見調查,十二位社區執業教師中一般反應良好。但少數教師覺得有下列因素稍微造成社區執業教師之困擾:由於教學導致時間上過於緊湊,無法妥善規劃個人時間(1位)、為兼顧教學,對病患之照護變得不足(2位)、為了教導學生,須額外付出心力準備資料或教材(3位)、多了醫學生參與,病患感覺不舒服或有微詞抱怨(5位)、診所空間不足,多了醫學生見習覺得礙手礙腳(3位)、診所其他工作人員無法配合教學活動或工作被干擾(2位)。學校也提出一些方案,例如以「提供輔助性教具」、「文具耗材核銷補助」、「彈性替代性學習時間選擇」、「發給感謝狀、資格證書或教學診所牌幟」、「教學績優者提供教職升遷機會」等來提高社區執業教師之教學意願。學生之反應不錯,從學生自我評估表發現社區診所課程確實讓學生認識了許多學校課堂上所不易體驗到的基層醫療實務。以Kolb所提「經驗學習理論」為基礎架構,針對學生的學習過程的學習型態加以記錄分析,學生仍期待以「回應觀察」及「抽象概念」等較被動的學習模式居多。結論:本研究顯示社區執業醫師執行社區醫學教學是一可行模式,課程中加入問題導向學習教學將可提高學生主動學習之成果。

English Abstract

Background and Purpose: Community medicine has become an important health care system in Taiwan. The purpose of this study was to evaluate the community medicine curriculum of medical students with community-based practitioners who have long-acting relationship with their patients and encounter greater diversity of community health problems as preceptors. Methods: This Community Medicine curriculum is under the infrastructure of newly reformed medical curriculum in one University and collaborated with the Department of Family Medicine in one medical center. We enrolled twelve community-based practitioners as preceptors and rotated the fourth year medical students to preceptors' primary care clinics located near the medical center. Each student played as a clerk in a clinic twice and learned the basic concept of community medicine from the preceptors. Results: According to the response from the community preceptors, all teachers responded well to the curriculum. However, some preceptors still complained busy in clinic work, crowd in the teaching place and had some complaints from patients and other clinics' personnel. Students also responded well that they learned a lot of primary care affairs from preceptors which can not be obtained in the traditional curriculum or in the medical center. According to the Kolb's experiential learning theory, most students expected learning models of reflective observation and abstract conceptualization which were more passive learning behaviors. Conclusions: Our results indicated that Community Medicine curriculum teaching by community-based preceptors is a feasible model in Taiwan. Adding the problem-based learning model in Curriculum will promote the student's active learning behavior.

Topic Category 醫藥衛生 > 醫藥衛生綜合