外科醫師學習效果之分析－－兼論工作地點移轉對於醫師學習之影響

An Analysis of Surgeons' Learning Effect: Accounting for the Impact of Workplace Switching

本研究使用1997－2008年之全民健保資料，以罹患子宮肌瘤並進行剖腹式子宮全切除手術之台灣婦女作為研究對象，探討外科醫師手術量與手術績效之關聯，並著眼於轉院醫師與非轉院醫師的差異性探討，以及層級別與移轉前後之學習速度變化。研究結果顯示轉院醫師與非轉院醫師皆呈現顯著之正向學習，且兩類醫師之學習速度在移轉之前並無顯著差異。此外，不僅外科醫師之學習速度會因醫院層級不同而有所差異，轉院醫師在進行層級間的移轉時，層級變化對於醫師的學習速度亦產生增強的效果；不過，移轉之後呈現顯著學習效果差異者，僅侷限於向上層級移轉（區域醫院轉至醫學中心，抑或是地區醫院轉至區域醫院或醫學中心）的醫師。 Drawn from Taiwan's National Health Insurance Database (NHID), data with inpatients underwent the uterine-leiomyoma-causing hysterectomy surgery during 1997-2008 are used to evaluate the association between surgical volume and outcome. We focus on examining the volume-outcome relationship from two distinct perspectives. The first involves the learning differences between switching and non-switching surgeons. The second concerns switching surgeons' mean differences in learning rate during the pre- and post-switching periods. Our result confirms the persistence of performance improvement as surgeons' trials accumulate, but find no significant learning differences between the non-switching and switching surgeons evaluated at the pre-switching period. Furthermore, in addition to hospital accreditation, an upward switching such as from the regional hospitals into the medical centers and from the district hospitals into the regional hospitals or medical centers, are found to explain the variations in learning rates among hysterectomy surgeons.

Drawn from Taiwan's National Health Insurance Database (NHID), data with inpatients underwent the uterine-leiomyoma-causing hysterectomy surgery during 1997-2008 are used to evaluate the association between surgical volume and outcome. We focus on examining the volume-outcome relationship from two distinct perspectives. The first involves the learning differences between switching and non-switching surgeons. The second concerns switching surgeons' mean differences in learning rate during the pre- and post-switching periods. Our result confirms the persistence of performance improvement as surgeons' trials accumulate, but find no significant learning differences between the non-switching and switching surgeons evaluated at the pre-switching period. Furthermore, in addition to hospital accreditation, an upward switching such as from the regional hospitals into the medical centers and from the district hospitals into the regional hospitals or medical centers, are found to explain the variations in learning rates among hysterectomy surgeons.