以問題導向學習教授醫學倫理之初步嘗試

Initial Trial of Problem-based Learning in Teaching of Medical Ethics Curriculum

10.6145/jme.200512_9(4).0001

賴明亮(Ming-Liang Lai)；趙可式(Co-Shi Chao)；陳興星(Hsing-Hsing Chen)；陳永榮(Yung-Zung Chen)；蔡明哲(Ming-Che Tsai)；李伯璋(Po-Chang Lee)；林其和(Chyi-Her Lin)；李坤崇(Kuen-Chorng Lee)

醫學倫理 ； 以問題為導向之學習 ； 教學法 ； medical ethics ； problem-based learning ； teaching method

Journal of Medical Education

9卷4期（2005 / 12 / 01）

1 - 11

繁體中文

為測試以「問題導向學習」(PBL)教學法，教授醫學倫理之可行性，我們在醫學院四年級之同學，連續兩年間，以前半段合堂上課，後半段PBL個案討論之方式，實施倫理教學。此課程為一學分，兩週上課一次，一次兩小時，以利PBL之推行。前半的內容在於哲學思維及尊重自主、行善、不傷害及社會正義四大原則之教學，後半段則採用了安寧療護，器官移植，和SARS的個案作為討論之對象。學生基本上可以接受這樣的教學方式，他們感謝這樣的教法可以提高思考能力，對將來和病人溝通、協調的重要性也更能體會。另一方面，對PBL個案的使用上，同學希望增加討論之個案數，另外，也期待在選擇上，讓個案的情況更適合於倫理原則之運用，如有牽涉太多法條的個案較不適用等。我們覺得，即使同一個案，時代不同，需要注意隨醫學進步而有不同的倫理考量。而師資之培養，亦是遂行倫理學PBL教學極為重要之因素。

A hybrid method was developed to evaluate the use of ”problem-based learning” (PBL) when teaching medical ethics. One third of this course was given as regular lectures to a relative large group of students and the other two thirds of the course were arranged as PBL discussion. The course was designed for students during their 4th year at Medical School. The first half of the lectures used a didactic approach with the main themes being the philosophical basis of ethics together with the four principles of respect, namely, autonomy, beneficence, non-maleficence, and social justice. Students then participated in PBL discussions on clinical cases that included ethical issues for two hours every other week. The cases used for the PBL studies were subjects related to hospice care, organ transplantation and SARS. The students appreciated this approach to the teaching of medical ethics using PBL. They agreed generally that the PBL discussions were able to help them think about the ethical issues involved in medical decisions and how they might communicate with the patients during later medical practice. Students also suggested that the number of case studies for the PBL discussions should be increased in the future. It was also noted that if the case is associated too much with legal issues, then the focus of the ethical discussion becomes blurred. Our experience indicated that, even when discussing the same PBL case, the appropriate decision might vary according to the available level of advancement of medical knowledge. We also need to acknowledge the importance of tutor training when teaching medical ethics by PBL.

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