“教學門診”中被指導醫師學習需求之評估

A Survey of Trainees' Needs and Requirements during Ambulatory Care Education

10.6145/jme.200706_11(2).0005

林姵君(Pei-Chun Lin)；陳芸(Yun Chen)；朱樹勳(Shu-Hsun Chu)

教學門診 ； 被指導者的需求 ； 教學品質改善 ； ambulatory care education ； trainees' needs ； requirements ； quality improvement in medical education

Journal of Medical Education

11卷2期（2007 / 06 / 01）

45 - 55

繁體中文

本研究的目的在瞭解參與教學門診之被指導者之學習需求，以本院參與教學門診之住院醫師及實習醫學生為研究對象。研究方法採用結構式問卷，共回收有效問卷47份，回收率為95.9%。研究結果發現，被指導者最期望指導醫師於教學門診教導用藥原則(93.6%)、病史詢問(91.5%)、身體檢查(85.1%)及溝通技巧(85.1%)；期望的教學門診評量方式以口試(55.4%)與實際演練(53.2%)居多；認為擔任教學門診的老師應具備的教學特質需求，以表達能力佳(95.7%)、能於教學門診前告知病患此為教學門診(89.4%)、能回應我的問題(89.4%)以及能給予學習上的回饋(89.4%)比例較高。最影響被指導者參與教學門診之因素，則以臨床業務纏身(80.9%)所佔比例最高。被指導者普遍認為一個月參與教學門診2次最適切，教學方式可採用學生先看診的方式進行，並給予合理的執行病史詢問、理學檢查及病歷寫作之時間各10分鐘為宜。研究的結果，讓我們了解被指導者對教學門診學習需求，做為未來執行教學門診的參考，以提升被指導者於教學門診之學習成效，確保教學門診之教學品質。

The purpose of this study was to investigate our medical residents' and students' needs and requirements during ambulatory care education. The study was conducted using a structured questionnaire. The number of returned and effective questionnaires was 47, giving a response rate of 95.9% (47/49). The results revealed that, during ambulatory care education, most trainees expected to learn more on the principles of prescribing (93.6%), the skills involved in acquiring a medical history (91.5%), the skills involved in making a physical examination (85.1%) and various communication skills. With regard to the assessment methods used for ambulatory care education, oral examinations (55.4%) and real situation tests (53.2%) scored highest with the trainees. Moreover, the study found that most trainees expected the teaching physician to have good communication skills (95.7%), to introduce the patients taking part in the ambulatory care teaching clinic in a kind way at the start of the examination (89.4%), to be able to resolve the students' questions (89.4%) and to provide the students with adequate feedback on their input (89.4%). The problem that interfered most during ambulatory care education was being bogged down in clinical details and being unable to see the full picture (80.9%). Most of the trainees were happy with two ambulatory care teaching clinics per month and enjoyed the process of interviewing patients under the supervision of the teaching physician. It was believed that the appropriate time needed for a trainee to take a patient's history, perform a physical examination and to write the patient's notes was 10 minutes for each of these. This study investigate the overall trainees' needs and requirements during ambulatory care education at our hospital and provides an important reference point that will help us carry out future modifications to and improvements in the quality of the ambulatory care education.

1. 中文。
2. Alison W,Martin M.Understanding patients' views of a surgical outpatient clinic.英文,273-280.
3. Bountry M,Synder C.Challenges and strategies for early professional experience case Western Reserve University's Family Clinic Program.英文,659-661.
4. DaRosa DA,Dunnington GL,Stearns J.Ambulatory teaching "Lite": Less clinic time, more educationally fulfilling.英文,358-361.
5. Dolan N.Using unidentified standardized patients to evaluate housestaff delivery of preventive services.英文,60-65.
6. Gruppen LD.Implications of cognitive research for ambulatory care education.英文,117-120.
7. Irby DM.Teaching and learning in ambulatory care setting review of the literature.英文,898-931.
8. Lesky LG,Hershman WY.Practical approaches to a major education challenge: Training students in ambulatory setting.英文,897-904.
9. Nair BR,Coughlan JL,Hensley MJ.Student and patient perspectives on bedside teaching.英文,341-346.
10. Norcini JJ,Blank LL,Arnold GK.The mini-CEX (clinical evaluation exercise): a preliminary investigation.英文,795-799.
11. Pantilat SZ,Lo B,Gallagher TH.Teaching medical students to discuss advance directives: a standardized patient curriculum.英文,142-147.
12. Perkoff GT.Teaching clinical medicine in the ambulatory setting. An idea whose time may have finally come.英文,27-31.
13. Rich EC,Crowson TW,Hamis IB.The diagnostic value of the medical history, perceptions of internal medicine physicians.英文,1957-1960.
14. Robbins As,Lussier RR,Koser K.A study of ambulatory care education in medical schools and U.S. Department of Veterans Affairs Health Care Facilities.英文,1-4.
15. Tamblyn RM.Impact of inaccuracies in standardized patient portrayal and reporting on physician performance during blinded clinic visits.英文,25-38.
16. Wartman SA,O''Sullivan PS,Cyr MG.Ambulatory-base residency education: Improving the congruence of teaching, learning, and patient care.英文,1071-1075.
17. Wykurz G.Patients in medical education: from passive participants to active partners.英文,634-638.
18. 王維典、鄭湧涇。應用醫療面談資料整理及認知圖發展生理、心理、社會層面之醫療面談技巧。中文，347-361。
19. 陳南松、趙冠雅、馮秀卿。某醫學中心教學門診計畫實施成效評估。中文，59-70。
20. 楊培銘。效率與成效兼顧之門診教學策略。中文，327-329。
21. 謝正源、楊順晴、尤詩妮。第二年實習醫師對「教學門診」制度之需求。中文，270-281。
22. 謝正源、楊順晴、王先震。國內某醫學中心實施「教學門診」後指導醫師滿意度調查研究。中文，147-158。
23. 謝正源、楊順晴、王如娥。臺灣甲類教學醫院「教學門診」實施之可行性與現況探討。中文，32-44。