醫學生抽血操作技能訓練與評估

Clinical Skill Training and Assessments on Phlebotomy for Medical Students

10.6145/jme.200809_12(3).0005

簡慈儀(Tzu-I Chien)；陳育婷(Yu-Ting Chen)；毛小薇(Siu-Mei Mo)；江福田(Fu-Tien Chiang)

靜脈抽血 ； 臨床技能 ； phlebotomy ； clinical skill training ； conventional rubber arm

Journal of Medical Education

12卷3期（2008 / 09 / 01）

35 - 43

繁體中文

醫學教育的目標是在培養醫師能以人文關懷為基礎，專業技能為核心，重視醫療安全與品質。在臨床醫療專業訓練中，抽血是醫學生首次面對的侵入性醫療行為，亦是必備的基本技能；完整的抽血過程涵蓋知識面、技術面與態度面。而抽血是檢驗醫學部主要業務之一，為拓展跨科合作，本部特別與教學部合作，辦理醫牙系學生抽血技能訓練課程。訓練課程採小組教學方式，包含核心課程與選修課程；前者包括：(1)講授課程；(2)教師示範；(3)以假手及同學互抽的實際技能訓練；後者為(4)臨床門診實務訓練。本研究以參與核心訓練課程之162名醫牙學系學生及參與門診實務訓練之55名學生為對象，分析其課程評估結果；課程評估包含學生對講授課程內容之滿意度評估（包括授課內容、口語表達、教材及整體性），以及指導老師針對學生臨床門診實際操作之技能評估。學生針對講授課程之評估結果發現，在12個不同領域之基本訓練課程中，本抽血課程各項滿意度及整體滿意度均排名第二。此外，針對55名參與門診抽血實務訓練之學生，制定15項技能評核內容與三項評估標準（通過、指正後通過以及不通過），每位學生分別負責10位病人。研究結果發現，針對15項分別評估，其各項評估內容之首次通過率平均為91.52%(54.55%-100%)；其中，「正確洗手」與「皮膚消毒完整」之首次通過率為100%，而「正確綁上止血帶、選擇適當抽血部位」首次通過率僅54.55%；不過經過老師提出修正建議後，就學生之第二位病人之操作訓練再度評估，15項評估內容所有學生全部通過。本研究結果顯示，以小組教學方式進行抽血技能訓練，配合客觀結構性臨床能力測驗(Objective Structured Clinical Examination, OSCE)，證實醫學生之抽血技能在良好規劃下，可依標準化訓練流程，達成完善的技能品管。

Blood tests and sampling are common routine procedures in daily medical practice. One of the essential procedures is phlebotomy which can induce patients' physical and mental discomfort, and further influence the quality of care and patient's satisfaction. The whole procedure of phlebotomy consists of different perspectives, for example, communicative aspects and core competence of skills. In the present study, a clinical skill training program on phlebotomy for the fifth-year medical students was designed, conducted and evaluated by the Department of Laboratory Medicine collaborated with the Department of Education at National Taiwan University Hospital. The program consisted of two sessions: required courses and clinical practice training. The required courses included:1) lectures (50 minutes); 2) teacher's demonstrations (30 minutes); 3) phlebotomy practice by using conventional rubber arms (30 minutes), and student-to student in vivo training (30 minutes); on the other hand, the clinical practice training on phlebotomy was implemented for those students who have completed the required courses, in which the participants were assigned ten outpatients to perform the phlebotomy under the direct supervision. 162 medical students from Department of Medicine (75.3%) and from Dental School (24.7%) were recruited to attend the required courses, and only 55 students voluntarily participating in clinical practice training after completing the courses. The present study used the course satisfaction questionnaire to measure students' satisfaction of the required courses in four dimensions: Contents, Verbal Expression, Teaching Materials, and Overall Satisfaction, and the clinical evaluation of students' clinical performance was coded by the supervisors through direct observation at the outpatient service. Regarding course satisfaction questionnaire, this clinical skill training program on phlebotomy was ranked the second compared to the other 12 courses provided by the Department of Education at the clinical skill training center during the same period. For the clinical evaluation on phlebotomy, the pass rates of each training item for the first patient were ranging from 54% to 100% with an average at 91.52%. However, all the students passed 15 items of training guidelines for the second patient after supervisors' correction. In conclusion, the present study demonstrated that a well-designed and structured clinical skill training program with a combination of lectures and clinical practice training could not only improve the quality of humane care, but also provide a basic model for training on the invasive medical procedure for medical students.

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