照顧肌無力症的里程碑計畫

The Milestones of Caring Patient with Myasthenia Gravis

能力導向醫學教育 （competency-based medical education, CBME） 已成為全球醫學教育的主流，美國醫學院協會 （Association of American Medical Colleges, AAMC）及畢業後醫學教育評鑑委員會（Accreditation Council for Graduate Medical Education, ACGME）也都訂出醫學生到專業醫師的可信賴專業活動（entrustable professional activities, EPA） 及里程碑（milestones）。國內專科醫師的訓練也配合衛福部「住院醫師計畫認定委員會」 （residency review committee, RRC） 的計劃，要求各專業醫學團體訂出專業訓練的里程碑。新光肌無力醫療團隊對肌無力症的全人照顧經驗豐富包含醫療專業及病友志工關懷兩大部分。將這兩大部分訂出照顧肌無力症病人醫師與志工的里程碑，對肌無力症的照顧能更全盤精實的照顧及對學習者更能客觀的評估。醫療的照顧已有許多制式的表格可應用，而志工方面，則是多年志工團體在照護病友的心得結晶。疾病同儕志工兼具病人及志工兩種身分。志工端，可以擔任醫療團隊全人照護中病人與團隊的「溫暖橋樑」，讓病人更容易親近醫療資源，來提升疾病的適應。在病人端的角色，透過專業的諮商訓練可以了解及落實諮商的技巧及疾病照護的基本原則，達到所謂「專家病人（expert patient）」的水平，不僅可以提供專業的諮商服務，更可以回饋自己在日後如何與疾病的相處。本文將多年來照顧此疾病的心得從這兩方面著手，訂出里程碑，對於此疾病的照顧能更精實合乎CBME 現代醫學教育的要求。

Competency-based medical education (CBME) has become the mainstream of current medical education. The Association of American Medical Colleges (AAMC) and the Accreditation Council for Graduate Medical Education (ACGME) have set up the entrustable professional activities (EPA) and milestones for all medical personnel from students to specialists. The ＂Residency Review Committee (RRC)＂ of the Ministry of Health and Welfare also followed this trend of milestones for all the specialist training. The holistic care of myasthenia gravis (MG) team at Shin Kong Hospital consists of two major cores: professional care and peer-supported care. The establishment of milestone for both neurologists and peer volunteers (PV) could provide more comprehensive care to the patients and more objective assessment to the learners. Medical care has been formulated by lot of standard forms used, and peer-supported care has been refined by the dedication from lots of PVs. The PVs play a dual role of patient and volunteer. As a volunteer, the PV can serve as a ＂warm bridge＂ between patients and medical teams to help patients getting easy access to medical resources and improving disease adaptation. The PVs as a patient, can learn and implement the basic principles of consultation skills and disease care through professional training to achieve the so-called ＂expert patient ＂ level for providing professional consultation services to peers and reflecting themselves for better disease adaptation in the future. Based on long-term experiences in treating MG, we set a milestone program for both medical professionals and PVs to comply with the requirements of CBME in modern medical education.