培養醫學生在醫療體系下行醫能力的新課程

A Novel Course for Fostering Systems-Based Practice Competency among Medical Students

10.6145/jme.201106_15(2).0004

鄭希彥(Shi-Yann Cheng)；陳偉德(Walter Chen)；黃俊寅(Chu-Yin Huang)；陳祖裕(Cho-Yu Chan)；李采娟(Tsai-Chung Li)

稱職能力 ； 醫療體系下行醫能力 ； 醫學生 ； 臨床輪訓課程 ； general competency ； systems-based practice ； medical student ； clinical rotation course

Journal of Medical Education

15卷2期（2011 / 06 / 01）

96 - 105

繁體中文

Objective: According to the Outcome Project proposed by the Accreditation Council for Graduate Medical Education (ACGME) in 1999, six general competencies are identified as requirements for physicians as part of competency-based education. Although the ACGME proposal was only applied to residents and fellows, the six competencies have also been adapted as education objectives during undergraduate medical education. Studies have showed that the training course and evaluation tool for ”systems-based practice” (SBP) are the most difficult to set up among the six competencies. The aims of this study were to design a novel SBP course and evaluate the outcomes in terms of reaction, learning and behavior with the Kirkpatrick's model. Methods: The 2-week SBP course included rotation among twelve blocks made up of nursing, pharmacy, radiology, laboratory-related work, registration, medical records, insurance, accounting, personnel/general affairs/medical service, administration, social work and integration block. The learning content in each block included ”the most important issue for each unit that most physicians do not know” along with the routine operation of various units. The contents used diverse methods including lectures, case workshops, case discussions and common questions/answers. The participants were 6th grade medical students, who formed groups of six or seven students. They took turns to participate in each SBP course. A ”Block Feedback Sheet” was introduced to assess the reactions of the medical students (Level 1 of Kirkpatrick's model). The assessment of the students' learning (Level 2) consisted of pre-test scores, post-test scores, the students' performance scores given by their block teachers and the student's participation in discussions during the reflection/feedback block. Furthermore, a preliminary assessment of behavior change (Level 3) was made based on submitted reports regarding students' commitment to behavior change and their desire to apply the content of the SBP course later in practice. Results: A total of 91 students took the SBP courses given by China Medical University Beigang Hospital during the 2009 academic year. Students' feedback on various block courses gave a satisfaction rating of 4.4±0.7 (Likert scale: 5 strongly agree; 1 strongly disagree) overall. When the learning outcome was assessed, the objective pre-test and post-test scores were 81.2±5.4 and 88.5±5.7, respectively, based on 40 multiple choice questions (one out of four answers is correct), which is an improvement of 7.2±7.0 (p＜0.00l, 95% confidence interval 5.8-8.7). Furthermore, the mean subjective score from the twelve blocks teachers was 83.4±13.0 and the mean participation score for the reflection/feedback block was 88.3±2.3. Finally, the mean preliminary assessment for commitment to behavior change at a later point was 88.4±3.4. Conclusion: The course does indeed successfully provide medical students with initial experiences in systems-based practice based on assessment at three levels, namely reaction, learning and behavior.

Objective: According to the Outcome Project proposed by the Accreditation Council for Graduate Medical Education (ACGME) in 1999, six general competencies are identified as requirements for physicians as part of competency-based education. Although the ACGME proposal was only applied to residents and fellows, the six competencies have also been adapted as education objectives during undergraduate medical education. Studies have showed that the training course and evaluation tool for ”systems-based practice” (SBP) are the most difficult to set up among the six competencies. The aims of this study were to design a novel SBP course and evaluate the outcomes in terms of reaction, learning and behavior with the Kirkpatrick's model. Methods: The 2-week SBP course included rotation among twelve blocks made up of nursing, pharmacy, radiology, laboratory-related work, registration, medical records, insurance, accounting, personnel/general affairs/medical service, administration, social work and integration block. The learning content in each block included ”the most important issue for each unit that most physicians do not know” along with the routine operation of various units. The contents used diverse methods including lectures, case workshops, case discussions and common questions/answers. The participants were 6th grade medical students, who formed groups of six or seven students. They took turns to participate in each SBP course. A ”Block Feedback Sheet” was introduced to assess the reactions of the medical students (Level 1 of Kirkpatrick's model). The assessment of the students' learning (Level 2) consisted of pre-test scores, post-test scores, the students' performance scores given by their block teachers and the student's participation in discussions during the reflection/feedback block. Furthermore, a preliminary assessment of behavior change (Level 3) was made based on submitted reports regarding students' commitment to behavior change and their desire to apply the content of the SBP course later in practice. Results: A total of 91 students took the SBP courses given by China Medical University Beigang Hospital during the 2009 academic year. Students' feedback on various block courses gave a satisfaction rating of 4.4±0.7 (Likert scale: 5 strongly agree; 1 strongly disagree) overall. When the learning outcome was assessed, the objective pre-test and post-test scores were 81.2±5.4 and 88.5±5.7, respectively, based on 40 multiple choice questions (one out of four answers is correct), which is an improvement of 7.2±7.0 (p＜0.00l, 95% confidence interval 5.8-8.7). Furthermore, the mean subjective score from the twelve blocks teachers was 83.4±13.0 and the mean participation score for the reflection/feedback block was 88.3±2.3. Finally, the mean preliminary assessment for commitment to behavior change at a later point was 88.4±3.4. Conclusion: The course does indeed successfully provide medical students with initial experiences in systems-based practice based on assessment at three levels, namely reaction, learning and behavior.

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