勝任能力導向醫學教育之推行與專業認同之轉變： 以台灣醫事放射職類為例

Abstract

背景：專業認同是職業人員如何理解並陳述作為專業人員的自己，不僅涵蓋專業技術，也與價值信念、倫理責任、人際互動與制度脈絡密不可分。近年醫學教育轉向以學習者中心、成果與能力導向的勝任能力典範，台灣醫事放射領域也自2014年建立五大核心能力，並於2019–2024年間陸續建置里程碑與可信賴專業活動等能力進展描述，推動臨床能力委員會整體評估與舉辦豐富師培課程推行能力導向醫學教育(Competency-Based Medical Education, CBME)。過去文獻發現CBME可以協助學生建立專業認同，然而關於在職人員的認同如何隨CBME推行而改變少見系統性分析，對醫事放射師的專業認同如何改變也缺乏在地化的研究。本研究旨在釐清台灣醫事放射師在CBME推行脈絡下，專業認同的具體變化與可能的作用機制。 方法：本研究採質性訪談方法，以北中部四家醫院的醫事放射師為研究對象進行半結構式訪談。訪談錄音轉錄為逐字稿後，資料分析採建構主義紮根理論(constructive grounded theory)取向，採取結構與歷程雙軌並行之編碼策略。針對 CBME 推行脈絡運用結構式編碼確立五大推動階段作為分析座標、針對專業認同變化內容則遵循歸納邏輯，經開放式編碼與聚焦編碼，透過不斷比較提煉出具解釋力的主題與次主題，藉此探索認同轉變與制度推行間的動態關聯。訪談與資料分析為同步進行，並迭代原則進行訪綱微調。訪談資料整理後與受訪者確認重要內容，研究過程亦有第二研究者參與分析增加研究效度。 結果：本研究在訪談十六位醫事放射師後達到理論飽和，訪談內容分析發現五項專業認同轉變的主題：職責、人際關係、專業定位、職業持續性及卓越文化。醫事放射師教能辨識溝通、團隊合作、回饋等非技術性能力但感受到教學相關工作負荷顯著增加。與同事及學員的互動更緊密，更清楚職類角色與特點，並提升職業可見度與被信任感。CBME促成職業的成長路徑與動機的顯化，但也注意到推行時伴隨不確定感與回饋多以認證、獎項為主。分階段比較顯示：評估工具與CCC階段最顯著連結到職責增加、師生及同儕關係緊密，與卓越文化，EPA與里程碑共識制定主要連結到專業定位與成長機會主題的轉變。 結論：本研究證實在台灣醫事放射CBME推行脈絡中，在職醫事放射師的專業認同發生轉變。專業認同轉變的面向，及推行各階段對專業認同影響並不均等的發現，可以於推行政策時考量嘗試緩解專業人員的負荷、強化意義感，促進在職者的長期專業認同培育及強化韌性。

Background: Professional identity (PI) is how practitioners understand themselves as professionals. It is inseparable from values and beliefs, ethical responsibilities, interpersonal interactions, and institutional contexts. The dynamic nature of professional identity is well-documented. While PI formation among healthcare professionals and clinical teachers has been extensively studied, little is known about how curriculum reform influences established PI. Competency-based medical education (CBME) represents a fundamental shift in curriculum design, but its impact on medical radiation technologists’ (MRTs’) professional identity as radiologic technologist remains unexplored. This study aims to elucidate, within Taiwan’s CBME implementation context, the shifts in MRTs’ PI and the potential mechanisms underlying these changes. Methods: This qualitative study used purposive sampling to recruit MRTs involved in CBME development and implementation across three subspecialties (diagnostic radiology, therapeutic radiology, and nuclear medicine) from four hospitals in northern and central Taiwan. Semi-structured interviews, guided by an expert-validated framework, were conducted. The interviews were recorded, transcribed, open coded and focused coded guided by constructive grounded theory. In parallel, CBME implementation stages were categorized to explore distinctive associations between identity changes and implementation progress. Interviews and analysis proceeded concurrently, with iterative refinement of the interview guide. Key points were member-checked with participants, and a second researcher contributed to the analysis to enhance study credibility. Results: Data saturation reached after 16 interviews. Five themes of PI shift were identified: duties and responsibilities, interpersonal relationships, professional position, sustainability, and a culture of excellence. MRTs increasingly recognized non-technical competencies (e.g., communication, teamwork, feedback) yet perceived a marked rise in teaching-related workload. Interactions with colleagues and trainees became closer; role and specialty characteristics were clarified, alongside heightened professional visibility and trust. CBME made career growth pathways and motivation more explicit, while its rollout was accompanied by uncertainty and external recognition primarily in the form of certificates and awards. Comparisons of different stages of CBME implementation showed that programmatic assessments were most prominently linked to increased duties, closer teacher–student/peer relationships, and culture of excellence, whereas specification of progressively sequenced competencies mainly linked to clarified professional positioning and growth opportunities. Conclusions: The professional identity of practicing MRTs is shifting within Taiwan’s CBME implementation context. Understanding this transformation is crucial, as the identified dimensions of PI shifts and the unequal impacts across implementation stages suggest policy efforts should consider mitigating practitioner burden and strengthening perceived meaning, thereby promoting long-term professional identity cultivation and enhancing resilience among healthcare professionals.