探討畢業後一般醫學教育訓練制度ACGME六大核心能力的成果：單一醫學大學附設醫院的經驗

Investigation of Residents' Performance in ACGME Competencies Following a PGY-1 Training Program: A Single Medical University Hospital Experience

前言：2003年爆發SARS（嚴重急性呼吸道症候群）大流行後，台灣醫學發生重大改革引進PGY-1（畢業後一般醫學教育訓練）制度。透過PGY-1教育，希望每一個醫師都有一個最基本的病人照護能力。能提供一個安全、符合實證醫學及人性化的醫療服務。ACGME（美國畢業後醫學教育評鑑委員會）六大核心能力是世界公認用來評鑑住院醫師能力的一個標準。PGY-1的訓練場所可包括急診、門診、病房、手術室及社區醫學。目前沒有相關研究到底那一個場所比較適合作為訓練ACGME六大核心能力。研究目的：測量急診及病房訓練ACGME（美國畢業後醫學教育評鑑委員會）六大核心能力的差異。研究方法：採觀察式研究方法，測量23位PGY-1學生在急診及病房訓練前及訓練後的成績。研究結果：PGY-1學生在急診及病房訓練後，其ACGME六大核心的能力都有明顯進步。研究結論：急診與病房的訓練同樣能增加PGY-1學生的ACGME六大核心的能力。

Background: In 2003, the post-graduate year (PGY)-1 system was implemented in Taiwanese medical education. This program ensured that all resident physicians in Taiwan would receive adequate training in the emergency medicine and other specialties such as community medicine, internal medicine, and surgery before entering their specialized resident training program in order to provide safe, evidencedbased, and humanistic care to their patients. However, the variations in training environments during these rotations continue to pose a challenge for residency training. Objective: To assess the effect of the program by measuring residents' performance on a 9-point scale for the Accreditation Council for Graduate Medical Education (ACGME) core competencies before and after completing emergency department (ED) and ward training. Methods: A cross-sectional survey study was conducted in a single medical university hospital. The performance of PGY-1 residents was assessed and rated before and after the training in the ED and in-patient ward. A nine-point Likert scale was used to measure each competency. A Wilcoxon signed-rank test was used to compare performance before and after training. Results: Twenty-three residents completed the training course in 2009. Their performance scores significantly increased in all six competencies after training in both the ED and ward. Conclusion: The PGY-1 training program in the ED and ward improved residents’ performance in all six ACGME competencies.