醫學生以病人為中心之醫療態度的演變

Abstract

以病人為中心的醫療態度對臨床實務上之醫病關係有著正面的影響，以病人為中心的觀念，並成為檢視人文教育成效之重要指標之一。本研究的目的是探討醫學生的以病人為中心之醫療態度在五年中的變化，及檢視大學多元入學方式與以病人為中心之醫療態度的演變之關係。是以2003年秋季入學，來自七所醫學院校的醫學系大一新生為研究對象，採長期追蹤研究的方式，以一具信效度之病人—醫療人員取向量表(Patient-Practitioner Orientation Scale, PPOS)來測量研究對象在四個時間點上，其以病人為中心之取向，並分析其入學方式對其演變之影響，PPOS分為分享和照顧兩個次量表。PPOS量表分析的結果顯示醫學生從一年級入學時，對病人—醫療人員取向的醫療態度是較偏向以病人為中心的，但是隨著時間的增加，以及隨著接觸的醫療專業愈多，則其逐漸偏向以醫師為中心的醫療方式，而女同學也較男同學傾向以病人為中心的醫療照顧。在檢視不同的入學管道而進入醫學系就讀者，雖然都呈現逐年下降的趨勢，但以推薦甄試和申請方式入學者，也比其他方式入學者，略為傾向以病人為中心的醫療照顧，而從不同管道入學的醫學生，在其五年中的演變也都略有不同。Patient-centered care has a positive impact on clinical outcomes in terms of the patient-physician relationship. Cultivating patient-centered care is considered to be one of the most important objectives of a medical student liberal education and the evaluation for medical humanistic education. The purpose of this study is to explore medical students' attitudes toward patient-centered care in medical practice and to examine the relationship between the direction of patient-centered care and the multiple channel university admission system. The subjects of the survey research were first-year medical students from seven medical schools entering in the 2003 academic year. This longitudinal study was conducted over the first three years of their training and then in their fifth-year at medical school in 2007. The Patient-Practitioner Orientation Scale ( PPOS), a validated instrument designed to measure individual preferences toward various aspects of the patient-physician relationship, was administered to these students. The PPOS is composed of Sharing (sharing information, take part in decision making) and Caring (respect for a person's feelings , interpersonal relationships) subscales. The total PPOS score can range from patient-centered (egalitarian, whole person oriented) to disease- or physician-centered ( paternalistic, less attuned to psychosocial issues). The impact of the multiple channel university admission system on medical students' attitudes toward patient-centered care was also analyzed. There was a significant decline in the PPOS score across the four measured years as well as a gender difference. Female students tended to be more patient -centered than the male students. A different pattern was found among those who had entered the medial school via the universities' diversified entrance system. Those who had become medical students by recommendation and application of an entrance system retained a more positive attitude toward patient-centered care. Although the declines in medical students' attitudes toward patient-centered care were not all statistically significant, the downward trend suggests that patient-centered care needs to be reemphasized at medical schools.