2016-08-012024-05-18https://scholars.lib.ntu.edu.tw/handle/123456789/702320摘要：現代醫療環境丕變，預期醫療糾紛的壓力，影響醫學生畢業後執業專科之選擇傾向 [1-3]。文獻指出，醫病溝通不良是醫療糾紛的重要危險因子之一[4-7]。醫師與病患的溝通方式，不僅來自於培育過程之知識架構[8，9]，也因病患特質而定。 神經質性格傾向之困難病患，經常形成溝通之一大挑戰[10-12]，甚至顯著增加醫師之心理壓 力及焦慮情緒[13，14]。增進醫師之情緒調適復原能力，亦有助於維持良好醫病關係[15-17]。文獻顯示七成住院醫師曾有醫病溝通困難之經驗，但教學課程能有助於了解預防醫療糾 紛之方法[18]。國内研究利用「客觀結構式臨床考試」評量七年級醫學生之醫病溝通能力， 發現其訓練未臻完善[19]。回顧當前醫學教育，尚缺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之配套整合課程。本研究企圖探討以醫療爭議情境與困難病 患為主題之醫病溝通課程，改善六年級醫學生因應高壓力醫療情境能力之效果。課程乃為期 六周之演講與小組討論，輔以網路影片，採取「問題導向學習」，並運用「客觀結構式臨床考 試」評估成效。課程設計基於認知行為理論，讓學生提早接觸高壓力醫療情境，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: The health care environment is changing. Concerns about malpractice liability has influenced medical students' career specialty choices [1-3]. Previous literature suggested that poor communication between physicians and patients was an important factor for malpractice lawsuit [4-7].The style of physician-patient communication is partly informed by medical education and partly depends upon patients' characteristics [8, 9]. Neuroticism tendency on patients' personality often increase the challenge for communication and increase the mental distress of the physicians [10-14]. Enhancing emotional resilience of the physician also helps to maintain a fair physician-patient relationship [15-17].Literature showed that seven tenth resident physicians has experienced difficulty in physician-patient communication, while a specifically designed training course improved their understanding on how to prevent medical disputes[18]. Some used objective structured clinical examination to assess the communication skills of interns found inadequate training that received in Taiwan [19]. Currently, our medical education is still lack of an integrated training course which consists the elements of physician-patient communication, medical dispute, coping with difficult patient, and resilience under pressure. In this study, we tried to investigate the effect of physician-patient communication training, which focused on managing medical disputes and difficult patients, on the ability of 6th-grade medical student to cope with high-pressure medical situations. The course adopts a problem-based learning approach, and is comprised of 6 weeks of lectures, small-group discussions, and video-assisted teaching on the Youtube. An objective structured clinical examination is held at the end of training to evaluate students’ clinical ability. The program design is based on cognitive behavioral theory, that early exposure on high-pressure medical situations will lead to systematic desensitization. In addition, the formation of positiverole model will facilitate learning of emotional management and building resilience under stress.醫病溝通醫療爭議困難病患醫學教育問題導向學習客觀結構式臨床考試Physician-patient communicationmedical disputedifficult patientmedical educationproblem-based learningobjective structured clinical examination