醫學生短期社區醫學訓練成效之介入性研究

An Interventional Study to Assess the Learning of Community Medicine by Medical Students Participating in a Short-Term Community Medical Training Program

醫學生之社區醫學訓練已是醫學教育中重要的一環，然而如何確認社區醫學訓練之品質與成效，亦是重要課題。因此，本研究之目的乃為評估醫學生社區醫學知識及態度，並比較及探討短期社區醫學實務訓練後的成效，以提供日後相關課程修訂之參考。本研究採單組前後測準實驗設計，針對60位醫六學生以「社區醫學的認知問卷」於為期一天之社區醫學實務訓練課程開始及結束時進行測驗。結果顯示，受測者的社區醫學知識前後評平均正確分數分別為0.50與0.54（範圍0-1；t=-3.240，p<0.001），在20題知識題中，有顯著進步者（p<0.05）僅2 題，其餘則無統計學上意義進步。此外，有9 題知識題前後測正確率不到一半，其中大多數為目前國內醫療體系的重要課題，值得探討及加強。於社區醫學信念方面，在正面信念題目中前後評明顯增加的有6 題（p<0.05），在負面信念中呈明顯改善的有3 題（p<0.05）。另外，前評時表達願意參與本社區醫學課程者佔81.7%，態度持中立者佔18.3%，後評時卻有百分之百醫學生願推薦此社區醫學之課程。本研究之結論，對於醫六學生，以一天的社區醫學實務參訪課程，社區醫學知識學習成效雖進步有限，但對社區醫學負面信念的改善以及對社區醫學重要觀念的修正卻深具意義，如此的課程設計於醫學生對社區醫學的認識有相當的助益，也可以為未來提供更完整的社區醫學訓練計畫之參考。

To have medical students participate in community medicine at an early stage in their training is essential in medical education. Hence, the quality and effect of community medicine training for medical students require more attention. In this research, the knowledge about, and the attitude toward, community medicine by medical students was evaluated. The results are discussed in light of their contribution to the future design of community medicine programs for medical students. A questionnaire was completed before and after a one-day community medicine training course by 60 medical students who attended the course. The results had accurate response rates of 0.5 and 0.54 in the pre-and post-courses, respectively (range 0-1; t=-3.240; p＜0.001). The results also revealed that the students made significant progress after the training course (p＜0.05) in only two of twenty questions pertaining to knowledge of community medicine. It is noteworthy that the medical students scored lower than 50% correctly on the nine questions relating to the current domestic healthcare system. Moreover, the accurate response rate showed a significant increase (p＜0.05) in six questions regarding positive beliefs in community medicine, while there was significant improvement in three questions pertaining to negative beliefs (p＜0.05). The majority of medical students (81.7%) were willing to participate in this community medicine course, whereas 18.3% of the students had a neutral opinion prior to this course. However, after the training course, 100% of the students showed an interest in all aspects of the community medicine course. This research concludes that for sixth year medical students, the effects of a one-day training course in community medicine knowledge were limited. However, the course had a significant impact on improving the negative beliefs held by medical students in community medicine and their awareness of vital concepts to community medicine. The design of this course also benefited students in terms of learning about community medicine learning and can thus be considered as the reference for a future training plan.