台灣甲類教學醫院「教學門診」實施之可行性與現況探討

the Feasibility and Current Status of Ambulatory Care Education in Teaching Hospitals in Taiwan

10.6145/jme.200209_6(3).0004

謝正源(Jane Yane Shieh)；楊順晴(Shun Ching Yang)；王如娥(Ju-O Carol Wang)；何善台(Shung-Tai Ho)；張聖原(Sun-Yran Chang)

教學門診 ； 醫學教育 ； ambulatory Care education ； Medical education

Journal of Medical Education

6卷3期（2002 / 09 / 01）

290 - 302

繁體中文

在醫師所有的診療行為中，「門診診療」的時間佔據了相當大的比率，但因為門診的特殊環境，使看診的醫師除了須具備高度的「專業知識」及豐富的「診療經驗」外，更須是一個好的「領導者」，才能帶領整個門診工作團隊，發揮最大的效能。因此門診經驗的傳承是醫師養成教育中很重要的一部份。在以往的醫學教育中，大多是讓學生模仿老師的診療模式及與病患的互動模式而已，較少透過適當的教學原理、方法、設備及理想的教學環境等完整的教學制度來傳遞教師的門診經驗。有鑑於此，近來除了國外已針對教學門診（Ambulatory Care Education）制度進行一系列的評估外，國內的醫學教育者，亦將「教學門診制度」的推行，列為醫學教育改革的重點項目之一，除了在「醫學系評鑑」中列為評鑑項目之一外，衛生署亦自九一年三月起編列補助計劃，邀請國內各甲類教學醫院共同推行「教學門診」制度，期望能對住院及見實習醫師，產生實質的教學成果。本文參考國外相關文獻發現，指導老師、教學環境、教學內容、評量及成本等五大因素將會影響該制度的推行，經評估國內現有之執行情況後，建議未來規劃「教學門診」制度時，應從實施前的準備作業、實施時的注意事項及實施後的評量等三方面全盤考量之，如此方可具有最佳的可行性及執行成果。

Of all the medical care a doctor provides, ambulatory care takes up a very significant proportion, but because of the special circumstances of ambulatory care, doctors providing it must have advanced professional knowledge, rich diagnostic experience, and good ”leadership” ability in order to lead the entire ambulatory care working team, and provide the most effective care. Thus, passing on experience in ambulatory care is an important element in medical education. In medical education in the past, most instruction in ambulatory care consisted merely of having the students imitate the teacher's diagnostic methods and interaction with patients, and seldom made use of the appropriate theories, methodology, and equipment which a comprehensive instructional system provides. In view of this, in recent years, other countries have already begun undertaking a series of evaluations of ambulatory care education, while in Taiwan, medical educators have also made the promotion of it as one of the most important elements of medical education reform. In addition to listing ambulatory care as one of the items for evaluation in medical education, the Department of Health, beginning in March 2002, has begun subsidizing a program allowing for the invitation of all class l teaching hospitals to provide ambulatory care education, in the hope that this will provide positive educational results for both residents and interns. After consulting relevant literature from other countries, this study found that instructors, environment, class content, evaluation, and cost were the most important factors influencing ambulatory care education. The study then evaluates current implementation of ambulatory care education in Taiwan, and suggests that future planning for it should include preparatory work before implementation, important issues during implementation, and evaluation after implementation, in order to optimize feasibility and results.

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