實證醫學的醫學教育

Medical Education and Evidence-based Medicine

10.6145/jme.200703_11(1).0002

余光輝(Kuang-Hui Yu)；陳永昌(Yung-Chang Chen)；田亞中(Ya-Chung Tian)；謝邦鑫(Pang-Hsin Hsieh)；簡竹君(Chu-Chun Chien)；方基存(Ji-Tseng Fang)

實證醫學 ； 醫學教育 ； 問題導向學習 ； 客觀的臨床能力測驗 ； evidence-based medicine ； medical education ； PBL ； OSCE

Journal of Medical Education

11卷1期（2007 / 03 / 01）

13 - 20

繁體中文

3,6傳統的醫學教育下，老師大量傳授知識，學生大多是被動記憶聽講與看書得到知識，若能以問題為導向及醫療情境教授而激發學生的學習興趣，更可提高學習的成效。國內外醫學教育也趨向主張讓醫學生提早接觸病人，以促進學生的主動學習，問題及病例導向學習方式的融入，可培養醫學生主動學習及終生學習的觀念。實證醫學是以流行病學和統計學方法，從龐大醫學資料庫中嚴格評讀、綜合分析找出值得信賴的部分，並將所獲得的最佳文獻證據，結合醫師的專業經驗及病人的價值觀與期待，整合應用於臨床工作中，使病人獲得最佳照顧。客觀的臨床能力測驗是以客觀的方式評估臨床能力的測驗方式的一種，也可以用來評估經過實證醫學訓練後，學生及住院醫師的臨床能力。我們建議各醫學院將實證醫學在見實習之前列為獨立的必修課程，並設計多元化課程，使學生進入臨床醫學學習時，除在校接受完備醫學知識外，能在實際照顧病人時提出問題、操作搜尋資料庫、及報告討論病例處置，使教學內容與應用能合而為一，並且與學校教育目標一致及接軌。

In traditional, faculty-centered clinical medicine teaching, students learn passively from lectures and reading books. A problem-based clinical scenario can promote interest in learning and improve learning effectiveness. Problem-based learning can be incorporated into clinical teaching so as to promote self-directed, active, life-long learning. Furthermore, emphasis should be placed on early clinical exposure, as an essential element in the medical curriculum, to improve self-directed learning. Evidence- based medicine (EBM) is defined as the integration of current best evidence with clinical expertise and patient values when making decisions about the care of individual patients. Evidence-based medicine helps students develop independent thinking and to build confidence in their critical appraisal skills. Objective structured clinical examination (OSCE) provides a uniform objectivity upon which a student's clinical competencies can be evaluated. The objective structured clinical examination technique also can be used as a tool for evaluating the decision-making ability of medical students and residents in evidence-based practice. We suggest that an evidence-based medical curriculum should be integrated into graduate and undergraduate courses, with the goal of improving the learning process and the competence of the interns and residents when entering clinical practice, thereby overcoming the limitations of traditional, lecture- based education. With such a curriculum, the goals of medical education and students' learning objectives can be merged together.

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