佛教慈濟綜合醫院住院醫師臨床教學技能之培訓－初步成效報告

Implementation of Clinical-teaching Skills among the Residents at Buddhist Tzu-Chi General Hospital. An Initial Report

10.6145/jme.200909_13(3).0004

朱紹盈(Shao-Yin Chu)；孫宗伯(Tzong-Bor Sun)；葉日弌(Jihi Yeh)；王英偉(Ying-Wei Wang)；王文利(Wen-Li Wang)；陳宗鷹(Tsung-Yin Chen)；劉鴻文(Hwan-Wun Liu)

住院醫師臨床教學技巧 ； 住院醫師為臨床教師 ； 病歷導向個案討論 ； 立即回饋系統 ； resident clinical teaching skills ； resident as teacher ； case based discussion ； IRS

Journal of Medical Education

13卷3期（2009 / 09 / 01）

182 - 190

繁體中文

目的：建構住院醫師臨床教學與評估的能力。對象：慈濟醫療體系住院醫師共184位。方法：依David Kern課程發展六階段模式規劃，先進行住院醫師教學上的需求評估，之後參照評估結果與國外住院醫師作為教師計畫(Resident-as-Teacher Program)內容設計實務工作坊，選擇一分鐘教師(one minute preceptor)，床邊教學(bedside teaching)實證醫學(evidence based medicine, EBM)，迷你臨床演練評量(mini-clinical evaluation exercise, mini-CEX)及病歷導向個案討論(case-based discussion, CbD)等5個教學與評估技巧，計畫性的培育住院醫師教學技能。執行策略以迷你演講及實務工作坊的形式進行，同時於院內新增教學行政法規，明確規範住院醫師於教學上的責任與義務。工作坊前後皆使用立即回饋電子輔助系統(immediate response system, IRS)進行前測與後測。工作坊結束後也進行課程滿意度調查，並利用SPSS軟體分析結果。結果：依教學需求調查結果我們瞭解到住院醫師原來就己承擔了教學的工作，內容多是傳授本科相關知識為主，住院醫師們一致認為教學是其本份也非常有興趣，前三名教學上的需求主要是如何帶頜小組討論、one minute Preceptor、與mini-CEX評估的技巧。最熟悉的教學技巧則為CbD。住院醫師們也贊成教學技巧的訓練要政策化，但在執行層面上部面臨了人力不足的困境。目前工作坊已進行三個場次，住院醫師的受訓率為29%(54/184)，IRS立即評估回饋結果顯示，住院醫師學習目標的達成率為95%，工作坊整體的滿意度以9級分而言皆超過7分，立即試測課程內容的學習效果也獲得一定的成效。課程的滿意度調查皆獲得正向的回饋。唯以小組模式進行，每次可容納人數並不多，是未來仍需不斷努力的地方。住院醫師也是教師是值得雅展與落實的培育計劃，成功與否仍待進一步臨床執行上的檢驗。結論：依住院醫師教學需求為導向的訓練是可以推行的計劃。提昇住院醫師的教學能力，賦予教學任務，可促進他們進步，所以「住院醫師也是臨床教師」計畫在臨床教學上值得積極推動。

Ami: To establish clinical teaching skills among residents. Methods: According to David Kern's six steps towards developing a teaching curriculum, residents' needs in terms of teaching skills are a priority. Five teaching and evaluation skills were selected as part of the residents' learning objectives within our teacher-training program. Teaching responsibility was clearly established and the training program was also linked to the resident's administrative promotion. An eight-hour workshop was implemented to teach the skills. The immediate response system (IRS) was used to assess the workshop and this used pre- and post-testing. The learner's degree of satisfaction with the workshop was analyzed statistically using the Package for Social Science (SPSS) software. Results: The residents were involved in teaching well before the training program was started. They had confidence in their teaching knowledge and understood that this course was the first course on teaching that they would undertake. They had the enthusiasm needed to teach and accepted that teaching was part of their responsibilities. Five teaching and evaluation skills were selected as the initial objectives. These were the one-minute preceptor, bedside teaching, case based discussions (CbD), mini-clinical evaluation exercises (Mini-CEX), and evidence based medicine (EBM). The fact that the definition of CbD among our residents was different from that of Foundation Program was discovered during the workshop. The barriers related to resident involvement in teaching included both a lack of manpower, and limitations in time. The learners' mean level of satisfaction with the workshop was 4.4 points. Conclusion: The implementation of a teaching skills program among residents, which will help them to create their own teaching platform, should increase their overall abilities. A Resident-as-Teacher training program is essential, and this is especially true for a teaching hospital.

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