畢業後一般醫學訓練住院醫師對訓練課程之觀點調查分析

Abstract

目的：本研究調查畢業後第一年(First postgraduate year, PGY1)住院醫師對一年期一般醫學訓練的看法及自覺學習成效。研究方法：以2006年度PGY1醫師為研究對象，問卷調查期間為2007年1月至6月。評估PGY1住院醫師自覺一期一般醫學訓練的幫助程度與壓力感受，以及以開放式題項探索其對此訓練之看法。資料檢測以質性分析法進行。結果：共有407 位PGY1住院醫師完成對一般醫學訓練幫助程度與壓力感受之評估。PGY1住院醫師自覺幫助程度依大小排序為專科全人醫療訓練、專科相關選修、一般醫學實務訓練、社區醫學基本課程、社區醫學相關選修。壓力感受程度大小依序為專科相關選修、專科全人醫療訓練、一般醫學實務訓、社區醫學相關選修、社區醫學基本課程。有467位PGY1住院醫師填寫對此訓練的看法之開放式題項。PGY1住院醫師認為一般醫學訓練能增進全人醫療能力、瞭解醫模式與行為及有助於生涯規劃，但課程內容不嚴謹、教學品質不穩定、重複實習醫師訓練課程及政文書作業太重。訓練時間不宜一年。結論：PGY1住院醫師著重專科相關訓練。一年期之一般醫學訓練課程需更嚴謹規劃方能提升學習成效。Purpose: The aim of this study is to investigate the perceived learning effectiveness of first postgraduate year (PGY1) residents and their viewpoints on general medicine training. Methods: PGY1 residents in the academic year 2006 were the study subjects. The study was conducted from January to June 2007. The degree of helpfulness and the perceived stress levels of the students were assessed. The approach to this assessment of the training program involved open questioning. The dataset was analyzed by qualitative methods. Results: A total of 407 PGY1 residents were assessed to explore the helpfulness of five training modules . The results gave the following decending order of helpfulness: the holistic care training in a specialty field , the specialty related elective course, general practice training, the basic community medicine course and the community medicine related elective course. The perceived stress levels for these courses, also in decending order, were: the specialty related elective course, the holistic care training in a specialty field, general practice training, the community medicine related elective course and the basic community medicine course. A total of 467 residents filled out the open questionnaire. Residents believed that the general medicine training was able to promote their holistic care competency and helped them understand the medical care model and medical care behavior as well as helping their career planning. However, the less concrete the teaching material, any fluctuation in teaching quality, overlapping of a course with internship and overloading with administrative clerical work were identified as weaknesses by the residents. Some even complained that the one-year training period was over-long and should be shortened. Conclusion: PGY1 residents were found to center their interest on training in their specialty. The planning of the one-year course should be more precise and concrete in order to promote learning effectiveness.