醫學生畢業時必備之基本臨床能力

Minimal Required Clinical Competencies of Medical Graduates-A Study of Competency Oriented Medical Education

10.6145/jme.200406_8(2).0005

劉敏(Min Liu)；黃裕勝(Yu-Sheng Huang)；劉克明(Keh-Min Liu)

醫學生 ； 基本臨床能力 ； 能力導向的醫學教育 ； medical student ； basic clinical competency ； competency-oriented medical education

Journal of Medical Education

8卷2期（2004 / 06 / 01）

168 - 188

繁體中文

醫學院醫學生的學习成果，應該要能夠反映而且逹到社會的需求。這些成果包括在從事醫療照護時的知識、技能、態度、價值觀等。美國、英國、澳洲、日本等國家都有訂出醫學生畢業時應該具備的最基本的臨床技能。本研究目的是要調查台灣醫學生畢業時，必須學會的各種最基本的臨床技能、臨床態度與臨床溝通技巧。參考外國醫學院畢業生應該具備之最基本臨床技能項目，整理出包含理學檢查的技巧、影像學的解讀、實驗診斷的技巧與判讀、程序上的技巧、治療的技術等五大類，共102個項目的臨床技能表，以進行問卷調查。問卷分送十一所醫學院校與三個醫學中心之醫學教育單位主管與醫師。回收問卷共123份，回收率49.2%，問卷結果顯示：除了「理學檢查的技巧」部分之「陰道檢查及陰道鏡的使用」，以及「程序上的技巧」部分之「子宫頸抹片與拭樣」、「子宫頸、尿道、與陰道的拭樣」、「關節囊的抽吸」、「肛门鏡」、「肝臟與腎臟切片」與「羊膜穿刺」共7個項目之外，在其他95個項目中，回答「非常同意與同意」的受訪者佔了50%以上。認为有必要建立基本臨床能力之核心課程者佔88.6%。這些基本臨床技能、臨床態度、及臨床溝通技巧，經過十一所醫學院校代表逐項討論並獲得共識，建議作为台灣醫學生畢業時必須學會之最基本的臨床技能、態度與溝通技巧，並提供各醫學院规劃臨床課程與未来醫師執照考試測驗臨床技能時之參考。

The learning outcomes of medical students should be able to reflect and meet societal needs. These outcomes include the knowledge, skills, attitudes and values that are performed in clinical practice. The minimal essential requirements of clinical skills for medical graduates have been defined in many countries. The purpose of this study is to determine the minimal required clinical competencies, attitudes and communication skills for new medical graduates in Taiwan. A structured questionnaire listing 102 clinical competencies in five categories [examination skills, visual image interpretation skills, laboratory skills and interpretation, procedural skills, and therapeutic skills] was mailed to medical education directors and physicians. They were asked if the skill is a「required competency, which a Taiwan medical graduate should be able to perform independently. The response rate was 49.2%. All clinical competencies, except for 7 invasive skills [vaginal examination include use of speculum; performing a cervical smear and take swabs; take swabs from cervix, urethra and vagina; knee joint aspiration; proctoscopy; liver or renal biopsy; amniocentesis], were ranked as a「required competency」by more than 50% of the respondents. Among them, 88.6% agreed the necessity of a core curriculum in basic clinical competencies. The results of this survey were discussed and used to achieve consensus among representatives from all medical schools in Taiwan. The basic clinical skills, attitudes, and communication skills listed in this study, should be used as a reference in clinical curriculum development and in the clinical skills examination of National Board Examination.

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