醫學生醫學核心能力之評估-以美國畢業後醫學教育評鑑委員會(ACGME)提出之六大核心能力為分析架構

Abstract

美國畢業後醫學教育評鑑委員會於1999年提出現代醫師須具備的六大核心能力，分別為：1.病人照護(patient care)2.醫學知識(Medical Knowledge)3.從工作中學習及成長(Practice-based learning and improvement)4.人際關係及溝通技巧(Interpersonal and communication skills)5.專業素養(Professionalism)及6.制度下之臨床工作(Systems-based practice)，然而臺灣現行也引進該制度並依該架構來評核及訓練我們的住院醫師，但從住院醫師訓練才開始評核是否為時已晚? 因此，本研究之目的為： 一、依據六大核心能力之規範，了解台灣醫學生較缺乏哪一項。 二、探討所缺乏之核心能力是否因性別、身分別及成績而有所影響。 三、所分析之結果將可作為臺北醫學大學醫學系之課程設計及改善參考。 本研究採隨機抽樣方式共收集57份跨領域臨床人文反思課程之學生作業進行分析，並使用SAS統計軟體以LOGISTIC迴歸進行分析。 研究對象為醫學系六年級已接觸過臨床實習工作經驗之實習醫學生，研究方法為從實習醫學生照護個案中所撰寫的反思心得，由課程負責教師共同針對該心得圈選出所對應的ACGME能力指標之後，再交叉檢視，分析其架構，透過SAS統計軟體針對性別、身份別、成績等來分析是否因上述因素造成缺乏的核心能力。 迴歸分析研究結果為學生之成績對於六大核心能力中之醫學知識具有顯著影響，而學生對於制度下的臨床工作能力被評定為較缺乏。 研究建議(1)針對制度下的臨床工作能力較缺乏，建議可於大一或大二時，設計一些和醫學制度相關課程供學生修習(2)僅有成績和醫學知識核心能力顯著相關，建議可再強化與其他核心能力相關之課程。

The Accreditation Council for Graduate Medical Education (ACGME) in 1999 proposed the modern physicians must have six core competencies, such as patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. The system was not only introduced to Taiwan, but also applied to resident’s evaluation and training courses. However, is it too late to start the evaluation at residency? Therefore, the objectives of this study were: First, to select which skills out of the six core competencies do Taiwanese medical students lack of. Second, to explore if the lack of core competencies be affected by gender, identity, and performance. Third, will the results be used as a reference for future course design at School of Medicine, Taipei Medical University. The study was randomly adopted from samples of 57 subjects from students’ homework of “Multidisciplinary Clinical Reflective Learning in Humanities”. The results were analyzed by SAS statistical software. The research subjects were sixth-grade medical students who had finished clerkship. The instructors select student’s reports that reflect that which competency that fitted ACGME, and analysis with Logistic regression. Finally, the instructors analyze different factors, including gender, identity, and academic performance, to determine which core competencies they are lacking. The results indicated that the grades have significant impact on medical knowledge of the six core competencies. In addition, systems-based practice is most deficient among the six core competencies. In conclusion, School of Medicine could design a series of courses that are related to medical system. Furthermore, School of Medicine could strengthen other courses that are related to medical knowledge of six core competencies.