一個臨床倫理繼續教育的運作模式與成效

An Operational Model for Clinical Ethics Continuing Education and Its Outcome

本研究旨在探討某醫學中心臨床倫理案例討論會的成效。研究參與者為該醫院的某兩科醫師、住院醫師及實習醫學生，每次平均參與人數約為20人。研究工具：結構式「關健事件表格」、半結構式深度訪談、參與觀察記錄、及會議回饋問卷。臨床醫師每月一次以結構式「關健事件表格」提出一個實際案例，由兩科主管埆同擔任主持人帶領討論，每次會議時間約60-80分鐘，會後進行問卷真寫。本研究收集十次會議記錄，並依方便取樣訪談6位住院醫師。結果顯示此討論會在事先預定的五大目標上有顯著的達成度，討論內容透露醫師所關注之六種倫理案例別與七項重要問題，主持人的帶領風格則呈現對討論會的不同影響，成員員的負面意見也一併被討論，研究者最後提出對未來臨床倫理繼續教育的建議。

This study aimed to evaluate the effectiveness of a monthly case conference in a medical center. The participants were composed of physicians, residents, interns and clerks from two departments, approximately 20 persons for each session. The research tools included structured critical incident report, semi-structured in-depth interviews, researcher's observation record, and a feedback questionnaire. The residents raised a real case every month and the director from each department led this conference. Discussion was typically guided via the structure of critical incident report which usually lasted about 60-80 minutes. Feedback questionnaires were collected at the end of each meeting. A convenience sampling of interviews was arranged outside the meeting. This study collected ten sessions of conference data and six interview data from the residents. The findings demonstrated positive result on five predetermined goals, six categories of ethical cases, and seven problems concerned mostly by physicians .The influence from different leadership styles on the discussion group as well as the negative feedback from participants were also discussed. The implications and suggestions from this study were brought out to enhance clinical ethics continuing education in the future.