臺灣家庭醫學科醫學生學習主題與核心課程內容之探討

The Learning Domains and Core Contents of Family Medicine Clerkship in Taiwan

目的：台灣各醫學院家庭醫學科實習課程時段從一週到六週不等，課程內容差異相當大，本研究透過混合設計方法來發展家庭醫學科醫學生之學習主題與核心課程內容以供各校課程設計的參考。

方法：在第一階段質性研究部分，邀請北部2家、中部、南部以及東部各1家，共5家醫學中心之15名家庭醫學科醫師與5名醫學生接受深度訪談，其中有3名醫師與1名學生另以焦點團體法進行資料收集。在第二階段量化研究部分，邀請7家醫學院家庭醫學科教學相關之27位主治醫師進行專家問卷調查，以階層分析法與模糊德懷術法進行重要性分析。

結果：透過深度訪談與焦點團體法建構出六大學習主題為家庭醫業、疾病不適、行為科學、預防醫學、社區醫學、與長照議題。每項學習主題各有知識、態度、技能三項課程領域，共計建構出18項課程內容。透過階層分析法顯示六大學習主題權重分數至少為0.1，顯示皆有其重要性。模糊德懷術法彙整出核心課程內容分別為學習家醫服務、急症處置轉介、體現病人中心、認識預防醫學、認識社區醫學與評估症狀功能。

結論：本研究擬出六大主題18項課程內容，可供各校依據其時數與資源特性選取適合的課程內容。

 

Purpose: The duration of family medicine clerkship (FMC) in Taiwan ranges from one to six weeks, and the contents of the program varies from hospital to hospital. The study accordingly aimed to investigate the learning domains and the core contents of FMC in Taiwan, based on a mixed method design.

Methods: For the qualitative content analysis of Phase One, 15 physicians and five medical students from five medical centers (two in northern Taiwan, one in central, one in southern, and one in eastern Taiwan) were invited to participate in an in-depth interview with three physicians and one medical student among the interviewees requested to join a focus group to collect data concerning their opinions about the goal, learning domains, and curriculum contents of FMC and their expectations and suggestions. For the quantity analysis of Phase Two, 27 professors of family medicine from seven medical schools were invited to complete an expert questionnaire on topics and contents of family medicine clerkship. The analytic hierarchy process (AHP) and the fuzzy Delphi method (FDM) were used to evaluate the importance of the topics and contents.

Results: Based on the results of qualitative content analysis, six learning domains and 18 curriculum contents were constructed. The learning domains included family practice, illness, behavior science, preventive medicine, community medicine, and long-term care. For quantity analysis, AHP found all the six learning domains important as their weighted scores exceeded 0.1. From FDM, the core contents of the six learning domains were respectively family practice, emergency referral, patientcentered care, preventive medicine, community medicine, and functional assessment.

Conclusion: The study used a mixed method design to construct the FMC training framework. 6 learning domains and 18 core contents are proposed and the results can be expected to provide medical schools with a reference for developing suitable syllabi meeting their individual needs and concerns.