從臨床照護趨勢與美國「家庭醫學未來計畫」談家庭醫學住院醫師之研究訓練

Resident Research Training in Family Medicine － The View of the Trend in Clinical Care and Future of Family Medicine Project

越來越多的趨勢期待醫師了解實證醫學，並依實證醫學的方法來照顧病人。ACGME （Accreditation Council for Graduate Medical Education）認為要將有關研究訓練教育納入所有住院醫師的訓練計畫之中，以用於改善病人的照護。2002年美國七大家庭醫學相關組織提出家庭醫學未來計畫（Future of Family Medicine Project），以因應健康照護環境的改變與符合民眾的需求，其提出新的家庭醫學執業模式係基於實證醫學，經由執業上的發現與研究來產生新的知識。文獻顯示對於住院醫師一年的臨床研究訓練可以增加研究相關的知識、能力和生產力，也可以改善住院醫師研究報告呈現、論文發表、激發研究興趣。基於ACGME教育核心課程要素之要求，住院醫師研究訓練核心課程的要素包括知識、態度、技能與過程四部份。雖然基層醫療的重要性與日俱增，然而其研究的產值卻相對較少。住院醫師研究訓練課程的障礙包括住院醫師、指導老師及機構三個層面。成大醫院家庭醫學部自2005年8月起更新住院醫師研究訓練課程之知識、態度、實作技能與過程四個層面，其最大的差異在於住院醫師在研究知識、態度、技能與過程四個層面的落實及由研究經驗較為豐富之資深主治醫師來指導住院醫師研究課程訓練，其成果呈現明顯的進步。總之，一個成功的住院醫師研究訓練計畫必須有良師的指導及接觸、基礎研究方法的訓練、給予適度的研究時間及支持環境，以訓練家庭醫學住院醫師成為臨床與研究能力兼具，並具備以實證醫學解決臨床問題能力的專科醫師。

Doctors must commit themselves to lifelong learning and they are increasingly expected to understand and apply methods of evidence-based medicine in patient care. The Accreditation Council for Graduate Medical Education (ACGME) advocates incorporating research into residency training for physician in order to improve patient care. In 2002, the Future of Family Medicine project of US was initiated to develop a new model of Family Medicine to transform the discipline of family medicine and to meet the needs of patients in a changing health care environment. As compared to consuming knowledge of traditional model, the new model is to generate new knowledge through practice-based research. Resident research training has been shown to increase research knowledge, interest, presentation skill and productivity. The curriculum element of resident research training includes knowledge, attitude, skill, and process, based on the ACGME education core curriculum requirements. Despite the size and importance of primary care, the research output has been relatively small. There are obstacles, including learner, faculty, and institution, encountered in implementing resident research curricula. We have renewed the resident research training program since Aug 2005 and there was a substantial improvement by implementing the knowledge, attitude, skill, and process into resident's project under the guidance of experienced teaching staff. In summary, a successful resident research training needs exposure to and guidance from mentors, training in basic research methods, protected time, and an environment supportive of research, and it will empower the residents to be ”bilingual” in clinical research methods and clinical medicine.