問題導向學習方法在醫學臨床技術課程的應用

The Application of Problem-based Learning to the Enforcement of the Clinical Skills Curriculum

10.6145/jme.200409_8(3).0003

劉樹泉(Lau-Shu Chuen)

問題導向學習 ； 臨床技術 ； 整合性教育 ； problem-based learning ； clinical skills ； integrated education

Journal of Medical Education

8卷3期（2004 / 09 / 01）

255 - 269

繁體中文

問題導向的學習是希望學生達到終身主動學習的境界，也是醫學教育目前主要的推動模式口臨床技術課程是醫學教育中重要的一環。課程的目的是：培養一位具全人觀念、術德兼備的醫師而非僅成為一位醫治器官的醫匠。基於此目標，這課程規劃的理念應該是：它是全人教育的一部份，所要求醫學生學習的不僅是一些刻板的技巧，同時也需培養他們良好的行醫行為。在施行這些行為於病人身上時，能及早診斷出病人的問題，加速恢復病人的健康與功能，減少病人的痛苦，才算是良好的醫療技術。要達到上述的目的，課程進行方式可以是：應用問題導向的學習模式，整合性的培養學生各種臨床醫療技術。在課程的評估原則方面，它必須能激發學生學習的動力，引導學習的方向，強調人際互動的重要，以及符合將來臨床實際情況。 國際上慣用的客觀結構式臨床測驗是一個很好的評估工具模式口臨床技術課程的目的、課程規劃的理念、教學的進行方式、課程的學習評估等都會影響醫學教育的最後結果。因此，清楚明瞭並確實執行這些重要的影響因素，將會是醫學教育成功的重要關鍵。台灣的醫學生是可以接受整合性的臨床技術課程教育的。

Problem-based learning is an important medical education model that has been applied recently. The clinical skills curriculum is an essential section of medical education. The aim of this part of the curriculum is to create a humane doctor that is not just a skilful medical technician because the aim of medical education is to improve the patient's whole life, not just save an organ. The central concept of the curriculum is an emphasis on holistic and humanity-based learning. Thus, the education does not concentrate only on the knowledge relating to disease or organic dysfunction, and the teaching does not target only stereotypic skills. The final outcome of this approach to medical education is professional behavior that identifies symptoms and signs from the patient promptly and efficiently to allow diagnosis followed by critical thinking and analytical behavior allowing the doctor to apply to the patient those appropriate actions that will promote recovery from illness, alleviate suffering, etc. The process of tutoring should therefore include problem-based learning that integrates the student's knowledge of basic science into clinical medicine. The assessment of the acquired clinical skills should follow the principles of the objective structured clinical examination. The aim, concept, tutoring methods and assessment parts of the clinical skills education will determine the outcome of this type of medical education and these will be discussed in the context of observations at Fu-Jen University, where it was shown that Taiwanese students are willing and happy to receive a comprehensive medical education centered on the problem-based concept. (Full text in Chinese)

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