臨床訓練及導師制度在醫學專業養成上的角色

Abstract

本研究以半結構方式訪談56位醫師，目的在探討醫師如何透過臨床訓練過程，以建立專業能力及專業素養。受訪醫師依年資深淺分為三組，比較此三組醫師對住院醫師訓練的內容及方法，以及完成住院醫師之後，仍須學習的地方的意見，藉以建構醫學發展的階段模式。研究結果發現，醫學專業發展一開始為生手階段，是擔任住院醫師 (約年資1-3年)的前數年，其主要的工作為熟悉與適應醫療專業體制。其次為建立專業能力的階段，相當於住院醫師訓練的後期 (年資4-7年)，其主要工作為在主治醫師的監督下，建立獨立執業的醫療專業能力。第三是持續精進專業能力的階段，此階段的任務為發展出以服務他人為導向的專業執業態度，大約是在成為主治醫師的前幾年 (年資6-12年)。最後的階段為專業精神的實踐，約為專業年資12年以上的主治醫師方能達到。此階段的醫師除了專業醫療能力之外，並具有專業素養，關注整個醫療系統的發展與醫學知識的進展。受訪醫師資料顯示，有資深醫師的指導是增進臨床醫學能力的主要方式，其中年資最高的主治醫師組曾在執業生涯中，遇見足以為榜樣的導師的比例最高 (65.0%)。本研究所建立之醫學專業發展模式可能推廣到其他專業領域。

Fifty-six medical doctors were interviewed to explore factors contribute to professional development in medical practice. They were classified into three groups according to their tenure. Similarities and differences among these three groups of physicians were analyzed according to a four-stage model of professional development. The data show that in the first several years, the fledging doctors are still novices. The major task at this stage (stage 1) is to learn the basic medical skills and routine operations of a hospital. About four or more years of clinical practices are required to assist them gain professional competences (stage 2). In medicine, residency training is a kind of supervised learning to help fledging doctors gain professional competences with assistance from attending physicians. Attending physicians with six to twelve years of practice may begin to show concern for the patients and patients’ family which characterizes the stage 3 professional development, namely, shifting one’s focus from self-centered practice to client-centered practice, and become an independent and responsible professional. Attending physicians with more than twelve years of experience might have reached the stage 4 development which is characterized by a high degree of professionalism and a continuous concern for profession’s future development. Almost all attending physicians considered one-by-one assistance from senior attending physicians the most effective way to help fledging doctors gain professional competences. Data also show that most attending physicians (65.0%) reported having met a mentor during their career development. A model of medical professional development was proposed and its educational implications discussed.