從多元課程評量分析學生對醫學倫理小班教學的期待與成效

Analysis of Students' Expectations and Learning Outcomes in a Medical Ethics Course

10.6145/jme.200903_13(1).0005

李錦虹(Gin-Hong Lee)；鄒國英(Kuo-Ying Tsou)；王志嘉(Chin-Chia Wang)；穆淑琪(Shu-Chi Mu)；邱浩彰(Hou-Chang Chiu)

課程評量 ； 醫學倫理 ； 教育成效 ； 學生期待 ； course evaluation ； medical ethics ； education outcome ； student expectation

Journal of Medical Education

13卷1期（2009 / 03 / 01）

35 - 48

繁體中文

本研究以多角度的評量來探討輔仁大學目前醫學倫理課程之教學成效，尤其著重在學生對課程期待的調查。本課程融合了調整的PBL教學法與大堂授課，受試者為52位醫學系六年級的學生，施測工具為：思考列舉法（前測），期末課程綜合評量（後測），以及醫學倫理課程態度問卷與傑佛遜同理心量表（前後測）。結果發現：學生對於醫學倫理課程與理想教學的思考列舉質性資料分析，出現下列幾個面向的看法：法律問題、內容主題、上課方式、對醫療現狀的看法、對課程結果的看法、以及專業認同。在期末進行的量性綜合評量的每一個項目，都達到顯著差異，這些包括：課程整體效果、自我投入、以及在六次PBL單元中對於主題安排、討論氣氛、以及小班導師帶領的滿意度都很高。前後測比較描述出今年課程之優點與理想課程之特色，但是學生還是認為課堂所學無法應用於臨床，期待課程提供更多對病患與對醫師經驗的體會，以及更實際與恰當的做法。此外，在課前臨床醫師的經驗分享非常受到學生的期待，但是，在課後學生對於角色楷模的期待卻明顯下降，值得進一步探討背後的原因。在同理心測量方面，則沒有任何一個題項達到前後測的顯著差異。建議未來的醫學倫理課程設計，應多增加體驗性與同理心的教學，並且強化對於醫學倫理議題的思辨與問題解決能力訓練。

This paper evaluated a medical ethics course at Fu-Jen Catholic University from multiple perspectives, in particular focusing on student learning expectations. This two-credit course comprised two traditional lectures and six problem-based learning sessions in one semester. Each session in turn comprised six small groups led by different tutors. The participants were 52 sixth-year medical students at the FJU College of Medicine. Evaluations were conducted at the beginning and at the end of the course. A thought-listing method was used as the pre-test instrument while the post-test instrument was a general course evaluation form and the pre-post test instruments were a medical ethics attitude questionnaire and the Jefferson Scale of Physician Empathy. The qualitative research findings from thought listing indicated that students attitudes toward medical ethics and an ideal course design concerned law issues, ethical themes, teaching methods, the current medical environment, expected learning outcomes, and professional identity. The quantative research findings in the post test suggested students were significantly satisfied with the general course design, self performance, and the six PBL sessions. Some positive attitude changes demonstrated the successful features of this course. However, students pointed out that there is a discrepancy between class learning and actual clinical application, and indicated that they expected more opportunities to gain a deeper understanding of the roles of doctors and patients as well as clearer problem solving strategies to deal with ethical dilemmas. Prior to the commencement of the class, students were eager to share the physician's clinical experience, but this tendency for role model learning was significantly decreased after the course. The underlying causes of this phenomenon are worthy of further exploration. None of the empathy scale items reached the pre-post statistical significant difference. The implications of all these findings for future course design in medical ethics are discussed in this paper.

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