臺中榮民總醫院實施畢業後一般醫學訓練計畫的探討

Study on Effect of a Post Graduate Year One (PGY1) Program in Taichung Veterans General Hospital (TCVGH)

目前醫學生畢業後，即選擇某一料別接受住院醫師訓練，但此一制度造 成許多醫師只會看某一料疾病，忽略了患者生病可能有多種病因作祟，也難 以照顧患者整體身心狀態，為此，衛生署已與專科醫學會達成共識， 所有第 一年住院醫師除了接受專科訓練外，還要挪出3 個月分別接受一般內料、一般 外料、基礎醫學訓練，訓練計畫由各教學醫院提出，納入社區防疫、法律、 醫學倫理等課程，讓醫師史具備公共衛生概念，也能顧及病人權益、尊重病 人隱私權，而非淪為看病的機器。 由於整個訓練計畫沒有標準化課程，僅就衛生署及醫策會的培訓目的和 教育重點，由各醫院自定內容。本文針對兩梯次的受訓學員，以問卷收集關 於課程和訓練相關的訊息，瞭解81 位學員之基本資料、工作場所，對畢業後 一般醫學訓練內容及訓練成呆的看法。結果呈現計畫主要遭遇的困難是課程 時間與醫療作業的衝突。其次，外科技術學習困難，主要是訓練時間太短， 建議延長時間。第三，多數認為PGYl 的訓練只比實習醫師少做雜事，其他學 習和工作並無差別。第四， 醫療倫理和臨床糾紛適合以互動討論方式進行。 且資料整理和成立臨床技術訓練中心對當前技術訓練與課程成效是有迫切需 要。

At present, medical students in Taiwan can choose only one specify department for resident training after their graduation. However, this forces physicians to focus on only one specialty of medicine, disregarding the fact that illnesses may be affected by various elements, causes, and it s hard to take care of patients physical and mental condition. Thus, the Department of Health and the Society of Specialty have reached a conclusion that all first-year residents need to receive three-month training in internal medicine, surgery, and community medicine, in addition to their specialty training. This is called post graduated year 1 (PGY1) program. This training program will be brought up by each teaching hospital, and community epidemiology, law, and medical ethics courses are included, It will allow physicians to be equipped with concepts of public health and understanding of patients rights, instead of just being a machine of seeing the patients. Since the training principle has not been standardized, this study surveyed the 81 trainees of two sessions and collected related information through questionnaire. The aim was to find out their personal data, work place, contents of PGY1 training, and the achievement of their program. There are four points reveal the difficulties in carrying out PGY1 program: (1) the time conflict between learning and clinical operation. (2) training time was too short for trainees to master techniques and skills of surgery. (3) most trainees felt no difference between PGY1 and internship training, only doing few chores. and (4) medical ethics and clinical lawsuits would be better taught through interactive discussion. Our study suggests that the training time should be prolonged, especially for the technique training of surgery. And it is urgently needed to establish a clinical skill center for organizing systematic data and setting up consistent training for clinical techniques.