主治醫師對畢業後一般醫學訓練計畫的認知與態度

Physicians' Knowledge and Attitude toward the General Medicine Training Program of Post-graduate Year One

胡文萍(Wen-Ping Hu)

指導教授 ： 楊哲銘

臺北醫學大學/公共衛生暨營養學院/醫務管理學研究所/碩士(2007年)

https://doi.org/10.6831/TMU.2007.00068

摘要

醫學教育一直以來為了因應醫療演進及病人需求而持續不斷的改革，「畢業後一般醫學訓練」計畫即是建立在以病人為中心的醫療精神下所推出的第一年住院醫師訓練計畫，本研究目的為探討主治醫師對畢業後一般醫學訓練計劃的認知與態度，採橫斷性研究，以立意取樣方式，由財團法人醫療品質策進會所公告之94學年度(2005年8月1日至2006年7月31日)參與畢業後一般醫學訓練之主要訓練醫院共23家醫院中，選取一家北部某醫學中心，以該院之主治醫師為研究對象，本研究採普查方法，以專任該院主治醫師共206人為研究母群體，總計發出問卷206份，回收有效問卷132份，有效問卷回收率為64.1%。
本研究結果發現，主治醫師對畢業後一般醫學訓練計畫的認知程度平均分數為69.39分，標準差14.317；對一般醫學訓練計畫之贊同程度，平均分數為3.12分，標準差1.075。主治醫師個人特質、個人相關經驗並不影響主治醫師對畢業後一般醫學訓練計畫認知與態度(F=0.901, p=0.57)；主治醫師年資(β=-0.041, p=0.008)、服務科別是否為畢業後一般醫學訓練單位(β=0.412, p=0.019)、同儕是否支持一般醫學訓練計畫(β=1.023, p<0.001)與主治醫師對畢業後一般醫學訓練計畫之態度有明顯差異，且達統計上顯著差異(F=4.667, p<0.001)。
依據研究結果，本研究提出以下建議：
一、建議衛生主管機關與各專科醫學會研議修改醫師專科制度，以落實畢業後一般醫學訓練並降低人力衝擊；針對畢業後一般醫學訓練計畫之實施成效執行全國性之評量，了解畢業後一般醫學訓練成果。
二、建議教育單位儘早改變醫學系學制，開始畢業後一般醫學訓練之長程計畫，具體紮實一般醫學訓練精神；灌輸學生畢業後一般醫學訓練之觀念及精神，以利未來推展畢業後一般醫學訓練計畫。
三、建議醫院管理者加強宣導畢業後一般醫學訓練計畫內涵、加強資深醫師對畢業後一般醫學訓練之贊同；並善用同儕支持，使主治醫師對畢業後一般醫學訓練實施精神及目的有具體正確的認知與積極正面的態度。
四、後續研究者可繼續進行全國性之研究、長期的追蹤研究、質性研究、成效分析，以及民眾與醫護人員對畢業後一般醫學訓練計畫的認知及態度差異分析，以了解畢業後一般醫學訓練計畫的實施成效。

關鍵字

一般醫學 ； 畢業後一般醫學訓練計畫 ； 認知 ； 態度

並列摘要

Medical education is innovated constantly as medicine and patient demand evolve. The training program of “post-graduate year one general medicine” is based on the principle of patient-centeredness. This cross-sectional study targets the physicians of one medical center which carried out this program from August, 2005 to July, 2006. The purpose of this study is to survey the knowledge and attitude of the physicians toward the training program. A total of 206 questionnaires were distributed with 132 questionnaires being returned. The response rate was 64.1%.
The results of this study are as follows. The average score for physicians’ knowledge toward the general medicine training program of post-graduate year one is 69.39. The standard deviation is 14.317. The average score for physicians’ attitude toward the general medicine training program of post-graduate year one is 3.12. The standard deviation is 1.075.
Multiple regression modeling (F=4.667, p<0.001) indicated the following factors can predict the physician’s knowledge toward the general medicine training program of post-graduate year one: the physician’s seniority (β=-0.041, p=0.008), whether the attending physician’s department has joined the general medicine training program (β=0.412, p=0.019), and whether the physician’s colleagues support the general medicine training program (β=1.023, p<0.001).
Based on the findings, the following suggestions are made.
(1)The health authorities and the medical specialty societies have to reform the training programs of medical specialties in order to fulfill the requirement of the general medicine training program of post-graduate year one, and to reduce the manpower impact. They also need to conduct a nationwide evaluation toward the effects of the general medicine training program of post-graduate year one in order to understand the impacts of the general medicine training program of post-graduate year one.
(2)The medical schools need to reform the medical education system as soon as possible and to design a long term program of the general medicine training of post-graduate year one in order to strengthen the essence of the general medicine training. They also need to teach students the concept and essence of the general medicine training program of post-graduate year one in order to facilitate the future promotion of the general medicine training program of post-graduate year one.
(3)The hospital managers need to strengthen the promotion of the general medicine training program of post-graduate year one, to gain the approval of senior physicians toward the general medicine training, and to make the best of colleague support, in order to have the physicians possess the correct knowledge and the aggressive and positive attitude toward the essence and the goals of the general medicine training program of post-graduate year one.
(4)The future researchers need to conduct nationwide researches, long-term follow-up researches, qualitative researches, effect analyses, and the variance analyses of the knowledge and attitude of the general public and medical personnel toward the general medicine training program of post-graduate year one, in order to fully understand the influences of the general medicine training program of post-graduate year one.

並列關鍵字

general medicine ； training program of post-graduate year one ； knowledge ； attitude

參考文獻

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