實習醫學生與不分科住院醫師對性少數族群的知識、態度、與臨床照護技能準備度研究

Abstract

研究目的 本研究旨在探討台灣北部某教學醫院實習醫學生與不分科住院醫師對性少數族群的知識、態度及臨床照護技能準備度。 研究方法 本研究為橫斷性研究，採用實體問卷施測的調查方式，對象為台灣北部某大學醫學院五、六年級實習醫學生及其附設醫院第一、二年不分科住院醫師。問卷內容涵蓋基本資料及知識、態度及臨床照護技能準備度之量表。資料收集期間自2023年2月至2024年9月，問卷分兩階段發放，第一階段收案150份，進行研究工具信效度分析；第二階段收案241份，第二階段有效問卷225份，進行描述性統計，獨立樣本t檢定與ANOVA比較各組間的平均數差異，皮爾森積差相關及線性迴歸，檢驗各變項之間的關聯性。" 結果 第一階段問卷經由專家效度（CVI = .967）與探索性因素分析之後，由原52題篩選出三大構面共30題之正式問卷。第二階段使用正式問卷施測，納入分析之有效問卷共225份，研究樣本的平均年齡為25.67歲，其中男性佔73%，女性佔27%。異性戀組（198人）的知識得分平均為41.5分，非異性戀組（27人）為45.56分。態度得分方面，異性戀組平均為50.11分，非異性戀組為52.52分。臨床照護技能準備度方面，異性戀組平均得分為23.75分，非異性戀組為24.78分。非異性戀族群在知識構面得分顯著高於異性戀族群（t = -2.941，p = .004）。不分科住院醫師（70人）在知識得分方面也顯著高於實習醫學生（155人）（t = -3.968，p < .001）。在性別方面，女性在態度構面的得分高於男性（t = -4.908，p < .001），但在知識及臨床照護技能準備度構面上無顯著差異。不同未來選科傾向在臨床照護技能準備度無顯著差異（F = 0.145，p = .865）。年齡與知識分別與臨床技能準備度呈正相關（r = .142，p = .033；r = .445，p < .001），而態度與臨床技能準備度無顯著相關（r = .037，p = .583），但態度與知識之間呈現顯著正相關（r = .230，p < .001）。單變量線性迴歸分析結果顯示，年齡和知識分別對臨床照護技能準備度有顯著正向影響（年齡：ꞵ = 0.142，p = .033；知識：ꞵ = 0.445，p < .001）。多變量線性迴歸顯示，在考量其他變項後，僅有知識對臨床照護技能準備度有顯著正向影響（ꞵ = 0.457，p < .001）。 結論 本研究結果顯示，非異性戀族群在知識得分上顯著優於異性戀族群，女性在態度構面得分高於男性，不分科住院醫師的知識得分高於實習醫學生。多元迴歸分析顯示，知識是影響臨床照護技能準備度的唯一因子。本研究發現，醫學生與不分科住院醫師對於性少數族群的知識，是臨床照護技能準備度的最重要因素。未來在醫學教育上，應重視多元性別課程，以提高醫學生及醫療人員對於性別的知識與敏感度，進而促進相關的臨床照護能力，以病人為中心，營造性別友善的醫療環境。

Objective This study aims to explore the knowledge, attitudes, and clinical care skill preparedness regarding sexual minority groups among medical students and postgraduate year (PGY) residents at a teaching hospital in northern Taiwan. Methods This cross-sectional study utilized a paper-based survey. The study population included fifth- and sixth-year medical students from a university in northern Taiwan and first- and second-year PGY residents at its affiliated hospital. The questionnaire consisted of basic demographic information and scales assessing knowledge, attitudes, and clinical care skill preparedness regarding sexual minority groups. Data collection took place from February 2023 to September 2024 in two phases. The first phase collected 150 responses to assess the reliability and validity of the research instrument. The second phase collected 241 responses, of which 225 were valid, and statistical analyses, including descriptive statistics, independent sample t-tests, ANOVA, Pearson correlation, and linear regression, were conducted to examine the relationships between variables. Results In the first phase, expert validity analysis (CVI = .967) and exploratory factor analysis refined the questionnaire from 52 to 30 items across three dimensions. The second phase used the finalized questionnaire, yielding 225 valid responses. The average age of participants was 25.67 years, with 73% male and 27% female. The average knowledge score was 41.5 for heterosexual participants (n = 198) and 45.56 for non-heterosexual participants (n = 27). Attitude scores averaged 50.11 for heterosexual participants and 52.52 for non-heterosexual participants. Clinical care skill preparedness scores averaged 23.75 for heterosexual participants and 24.78 for non-heterosexual participants. The knowledge scores of non-heterosexual participants were significantly higher than those of heterosexual participants (t = -2.941, p = .004). PGY residents (n = 70) had significantly higher knowledge scores than medical students (n = 155) (t = -3.968, p < .001). In terms of gender, female participants had higher attitude scores than males (t = -4.908, p < .001), but no significant differences in knowledge or clinical care skill preparedness scores. Future specialty preferences did not significantly affect clinical care skill preparedness scores (F = 0.145, p = .865). Age and knowledge were positively correlated with clinical care skill preparedness (r = .142, p = .033; r = .445, p < .001), whereas attitudes were not significantly correlated with clinical care skill preparedness (r = 0.037, p = 0.583) but were positively correlated with knowledge (r = .230, p < .001). Univariate linear regression showed that age and knowledge positively influenced clinical preparedness (Age: β = 0.142, p = .033; Knowledge: β = 0.445, p < .001). Multivariate linear regression revealed that after adjusting for other variables, only knowledge had a significant positive impact on clinical care skill preparedness (β = 0.457, p < .001). Conclusion This study found that non-heterosexual participants had significantly higher knowledge scores than heterosexual participants, female participants scored higher in attitudes than males, and PGY residents had higher knowledge scores than medical students. Multivariate regression analysis identified knowledge as the sole predictor of clinical care skill preparedness. These findings highlight that knowledge of sexual minority groups is the most critical factor influencing clinical care skill preparedness among medical students and PGY residents. Future medical education should emphasize gender diversity curricula to enhance the knowledge and sensitivity of medical students and healthcare professionals, thereby improving their clinical competencies and fostering a patient-centered, gender-inclusive healthcare environment.