實施「畢業後一般醫學訓練」後學員的學習成效初探

Preliminary Research on the Effectiveness of the Post-Graduate Year One Training Course

國內自2003年起公告實施「畢業後一般醫學訓練」，並將自2006年7月開始從三個月的學程延長為一年。本研究欲了解自2004年8月自2006年7月止，開始使用「學習護照」為評量依據，於本社區型醫院接受一個月的社區醫學訓練後，住院醫師在認知期待與自我評量上之學習前後的差異，以初步了解學員的認知與看法及訓練的成效。利用醫策會所頒定具有一定專家效度的認知與期待問卷與「社區醫學課程學習護照」作學習的前後評量熟悉度變化的紀錄為測量工具。顯示一個月的課程介入後，對在該院受訓的學員對PGY1訓練有正面認知提升，且在醫學中心PGY1學員的認知同意度普遍性地高於社區型醫院PGY1學員；特別是醫學中心學員在後測中的「您是否同意住院醫師一般醫學的訓練至少需要一年的時間？」與在前後測差異的「您的志向是否規劃要成為一位次專科醫師」皆顯著大於社區醫院組學員。在學習護照的自我評量中，亦呈現前後測的熟悉程度全面上升，顯示所有學員在課程介入前後有一定程度對評量項目的內容了解與學習認知成效。而學習前後差異最大的為社區醫院學員對社區公衛群與社區醫療體系角色與功能，熟悉度提升最多；外科系學員在成人預防注射與衛生所公共衛生業務方面，熟悉度提升最多。整體課程安排滿意度雖高，但仍有許多缺陷與空間需要改進與繼續努力，而長期的訓練學習成效，也值得後續的研究與觀察。

In 2003, the implementation of The ”Post-Graduate Year One (PGY1) General Medicine Training” was announced, with a program launch scheduled in 2006. The purpose of the current research was aimed at determining the differences in the PGY1 resident's cognitive expectations and self-evaluations before and after completing 1 month of the ”PGY1 Community Medicine Training” at community hospitals. The ”Learning Passport” was used as the tool for the evaluation process. Therefore, we can determine their cognitive opinions and the primary effects. We adopted the cognitive expectation questionnaire developed by the Taiwan Joint Commission on Hospital Accreditation (TJCHA) as the measurement tool to assess the difference before and after training. It demonstrated that the PGY1 resident in the community hospital showed an increase in their cognition during the PGY1 training course. Those in the medical center had higher cognitive agreement than those in the community hospital. From the result of self-evaluation of the ”Learning Passport,” it was also demonstrated that the degree of familiarity after the training was higher than before the training. The most significant difference was that community hospital PGY1 resident became much more familiar with the role and function of public health and community medical integrated delivery system. The PGY1 resident from Department of Surgery become much more familiar with adult protective inoculations and public health administration. In conclusion, the PGY1 resident who took the Community Medicine Course showed a significant improvement in their learning cognition and satisfaction. We still need to monitor the long-term post-training effects in follow-up research.