從教室中問題導向學習到職場中全人整合照護

From Problem-Based Learning in Classrooms to Holistic Health Care in Workplaces with Special Emphasis in Chinese Societies

As PBL continues to represent the most effective medical education in theory by virtue of its self-directed learning (SDL) and student-centered learning (SCL), world-wide and in Asia-Pacific region, PBL remains illusive in the way it has been practiced and the direction it is leading to in Taiwan and China. Here we would like to stress on two points: (a)PBL is an end result of societal progress; (b)PBL represents a paradigm shift in medical education. These two points would make PBL an inevitable mode of future education in medicine and the basis for clinical training on holistic health care. Holistic health care represents a comprehensive model of translational medicine which aims to treat an individual patient as a whole. When holistic care is applied to family as a whole, it turns into family medicine. Holistic care has been widely practiced in the West, and is an area only being developed in Taiwan and underdeveloped in China. Interestingly, this seems to parallels with the corresponding development of PBL in medical education in these regions. Holistic care system deals with total patient-centred care that considers the physical, emotional, social and spiritual needs of the person, his/her response to illness, and the effects of the illness on the ability to meet patient's self-care needs. The condition of the whole person is taken into account by health care investigators and providers during the learning, research, assessment, diagnosis, planning, intervention and evaluation of the results in all healthcare settings as well as stages of education and personal life. To nurture the knowledge, attitude and ability for holistic care providers, education and training should start from early years of undergraduate education through PBL or TBL and basic-clinical integrated modules and hidden curriculum to clinical years in internship and postgraduate years by evidence-based medicine (EBM), narrative medicine, role modeling, case-presentation (including Case-based learning: CBL), inter-professional learning (IPL) and other forms of blended learning in clinical setting, such as integrated care conference for selected outpatients and inpatients. A high quality of clinical practice will certainly facilitate holistic care for busy care providers. This requires establishment of an efficient informatics system coupled with an effective management for health services. center for faculty development to nurture holistic health care trainers and utilization of healthcare matrix, including holistic care checklist. Mini-clinical evaluation exercise (Mini-CEX) covering all aspects of holistic care is recommended for the assessment of the effectiveness of holistic care education and training.