台灣地區醫務管理科系學生對疾病分類課程的學習評價與從事相關工作意願之調查

A study on Students’Attitudes and Evaluations toward Curriculum of Disease Classification and Their Working Intentions in Department of Hospital and Health Care Administration in Taiwan

疾病分類工作在全民健保醫療費用申報中扮演一個重要的角色。疾病分類編碼的正確性與完整性奠定了未來實施診斷關係群（DRG）的基礎，且關係到醫療費用是否被核減，進而影響醫療收入。疾病分類人員的養成來自最基本的學校教育，而此課程目前普遍被安排在醫管科系。本研究的目的是為瞭解學生對疾病分類課程之評價、學習是否困難及畢業後是否參加甄審考試的動機和理由。故以87年度全國醫管科系中有研修疾病分類課程的硬屆畢業生為研究對象，採問卷調查法，設計學習成果評量表，內容包括課程安排、老師教學方法與態度、同學間的學習氣氛、自覺課程的重要性、學習成果和未來從事疾病分類工作的意願等六部分，以分層集群抽樣法抽取樣本，發出911份問卷，回收810份，回收率88.9%，有效樣本780份。結果發現：1.在課程評價方面：正面評價的項目是教材內容編排順序、老師上課方式、老師表達與說明、老師與學生互動、老師回答問題、自覺課程的重要性和對成績的滿意度。負面評價的項目是教材內容的難易度。2.夜間部學生對老師上課方式、同學上課學習態度及課程的興趣評價高於日間部，但對課程內容評價卻低於日間部。有95.6%的學生認為學習上有困難，理由依序是；解剖生理學基礎差、編碼規則非常繁雜、上課時數不足。3.學生畢業後會去參加全國性的疾病分類人員甄審考試者有20.4%，理由以證照是醫管的一項專業證明為主。但有將近三分之一的夜間部學生卻不知有此項訊息。4.考上後會去從事疾病分類工作的情形：有68.5%學生表示考上後會去從事疾病分類工作，其主要理由也是此工作是醫管的一項專業證明。建議在各學制低年級時，就應加強解剖生理、病理學等專業術語和英文結構能力。日夜間部的課程安排應有所不同，上課方式多採用小組討論，以增進同學彼此的互動，提高學習興趣。

Diseases coding plays a very important role in the National Health Insurance（NHI）program. The accuracy and completeness of coding can affect implementation of DRGs and medical revenues of hospitals. The training program of ICD-9-CM coding is arranged at departments of hospital and health care administration in our education system. Purposes of this study are to understand students’ attitudes and evaluations of curriculum, the difficulties on learning and motivation of attending exam. Questionnaires were conducted to exam students’ assessment of learning. Contents of questionnaires included arrangement of curriculum, satisfaction of learning attitudes toward teaching methods and influences of curriculum on classmates, and work intentions. 911 questionnaires were distributed and 780 effective cases returned. Results of this study show 7 positive items on the assessment of teachers, interactions between teachers and students, importances of curriculum and satisfaction with assessment. The negative item is difficulty of teaching materials. Students of night schools have better attitude toward teaching methods, classmates’ influence and curriculum than those in day schools. But attitude toward assessment of teaching materials is worse for students in night schools. Of all samples, 95.6% students recognizes that ICD-9-CM is difficult, reasons are poor knowledge of anatomy and physiology, complex of coding rules, and insufficient class hours. 20.4% students will attend national examination of disease classification, because it is only one certification in this field. But one-third of students in night schools didn’t know the in-formation about exam. 68.5% students showed working willness after they pass the examination. Suggestions of this study are anatomy and physiology and professional terminologies should be emphasized. Arrangement fo curriculum should be different between day and night class. A team discussion can be used to improve interactions and learning interest in class.