某社區型醫院執行畢業後一般醫學訓練社區醫學課程之五年經驗探討

The Five-Year Experience of Community Medicine Training Program for Postgraduate Education in General Medicine

目的：傳統畢業後醫師在第一年即投入選擇的科別接受專科訓練，思考診斷專精於受訓領域。2003年3月嚴重急性呼吸道症候群的衝擊突顯了一般醫學教育的重要性，行政院衛生署於是在92學年度起實施畢業後一般醫學訓練計畫。本研究為臺北市立聯合醫院陽明院區承辦社區醫學課程之經驗報告。方法：以92至96學年度學員滿意度、課程助益程度、雙向溝通意見，及社區教學單位意見資料進行整理與分析。結果：基本組161位學員中，145人(90.1%)表示非常滿意或滿意。實務組24位當中21人(87.5%)表示非常滿意或滿意。不同科別學員的滿意度呈顯著差異，且內科(4.4)學員給分有比精神科(3.8)高一些的傾向，家醫科與非家醫科則無顯著差異存在。基本組三大課程：社區導向基層醫療實務、生物心理與社會層面之全人照顧、整合性健康照護體系當中，在95年度社區導向基層醫療實務(4.1)的分數顯著高於整合性健康照護體系(3.5)。而在92年度、93年度、94年度與96年度的分數則無顯著差異存在。另外，學員對於課程及老師表達感謝與肯定，但認為社區課程交通壓力很大且積極提出多項建議。在社區教學單位的意願部分，私人診所(3.5)與社區照護機構(3.6)的教學意願顯著低於聯合醫院(4.6)。部分社區單位教學意願不足共造成十九個教學單位停止教學，原因主要有業務繁忙或人力不足、教學補助金額不足、PGY學員表現不佳。結論：本研究歸納五年來辦理畢業後一般醫學訓練計畫的經驗，希望可以作為未來規劃與執行社區醫學訓練課程時的參考。

Background: In 2003, the Department of Health initiated its postgraduate year one (PGY1) training program in general medicine. The purpose of this study is to assess the community medicine training program provided by the Department of Family Medicine in Taipei City Hospital, Yangming Branch. Methods: The timeline of this study was from 2003 to 2007. It covered community medicine and community practice courses, the teacher-student communication, and overall discussions. Surveys were carried out to determine student satisfaction, expectations of community groups, and reasons for ending the training program during the integration of community teaching resources. Results: Students were satisfied with the one-month basic community medicine courses and one-month practical community medicine courses. The COPC (community oriented primary care) was more helpful than the IDS (integrated health delivery system) in 2006. There was a significant difference in student satisfaction with different departments. Hospital staff were more willing to teach than were clinic staff. As communicated to their teachers, participants expressed their appreciation for the strengths of community teaching groups and teachers, the practicality and helpfulness of courses, the impact on future life, improvement in education and reduced pressure associated with community classes, etc. Conclusion: This research summarizes the 5-year experience of participants in a postgraduate general medicine training program. We hope it will be a reference for future planning of community medicine training programs.