2017-08-012024-05-18https://scholars.lib.ntu.edu.tw/handle/123456789/700271摘要：預期醫療糾紛的壓力與情緒勞務，會影響醫學生畢業後執業專科之選擇傾向[1-3]。醫病溝通不良是醫療糾紛的重要因素[4-6]。醫病溝通方式，不僅來自於培育過程之知識架構[7,8]，特定神經質性格傾向之困難病患，也經常形成溝通的挑戰[9-11]，甚至增加醫師心理壓力及焦慮情緒[12]。增進醫師之情緒調適復原能力，有助於維持良好醫病關係[13, 14]。回顧目前醫學系教育學程中，缺乏整合醫病溝通與醫療爭議、困難型病患處遇、以及醫病互動壓力復原力(resilience)之配套整合課程。過去針對醫學人文教育之回顧檢討文獻亦指出：理想的課程必須在不同年級間有所聯繫貫穿，甚至必須延伸到畢業後的教學醫院課程[15]。本研究整合醫病溝通及情緒復原力等主題於(1)大二醫學心理學；(2)大四臨床醫療總論；(3)大六實習醫學生於精神科學習；(4)畢業後不分科住院醫師訓練等，以改善醫學生及醫師因應高壓醫療情境能力。實施方式包括演講與小組討論，輔以網路影片，採取「問題導向學習」，於大六運用「客觀結構式臨床考試」。課程設計基於傳統壓力負載(allostatic load)生物學理論衍生之復原力增進策略[16-18]，讓學生逐步由理論學習，技巧練習，困難個案進階挑戰，達到系統性減敏之效果，並藉由教師建立正向模範，促使學生習得情緒管理，增進在壓力之下的復原力。<br> Abstract: Concerns about malpractice liability and emotional labor have influenced medical students'career specialty choices [1-3]. Poor communication between physicians and patients was animportant factor for malpractice lawsuit [4-6]. The style of physician-patient communication ispartly informed by medical education and partly depends upon patients' characteristics [7, 8].Neuroticism tendency on patients' personality often increase the challenge for communication andincrease the mental distress of the physicians [9-12]. Enhancing emotional resilience of the doctoralso helps to maintain good physician-patient relationships [13, 14]. A review study on Taiwanmedical education is proposed the longitudinal integration of curriculums of medical humanity for all grades of medical students[15]. Currently, our medical education is still a lack of an integratedtraining course which consists the elements of physician-patient communication, medical dispute,coping with a difficult patient, and resilience under pressure. In this study, we tried to integratemedical curriculums focused on physician-patient communication and emotional resilience, whichscattered in medical psychology at 2nd year, clinical medicine at 4th year, a clerkship in psychiatryat 6th year, and at PGY program. It is expected to improve the ability of the medical student tocope with high-pressure medical situations. Trough undergraduate to postgraduate year, theintegrated course adopts a problem-based learning approach, small-group discussions, and videoassistedteaching on the YouTube. The objective structured clinical examination and ordinalevaluation are held to evaluate students’ knowledge and clinical ability. The program design isbased on allostatic load and resilience theories, that early exposure to high-pressure medicalsituations will lead to systematic desensitization[16-18]. Also, the formation of positive role modelwill facilitate learning of emotional management and building resilience under stress.情緒復原力醫病溝通困難病患問題導向學習客觀結構式臨床考試不分科 住院醫師Emotional resiliencephysician-patient communicationdifficult patientproblembased learningobjective structured clinical examinationpost-graduate year medical resident (PGY)