從專科醫師訓練課程到醫院認定談台灣家庭醫學住院醫師訓練

Family Medicine Residency Training in Taiwan: from Curriculum to Accreditation

台灣最早家庭醫學專科相關訓練起始於1976年臺灣省衛生處委託臺大醫院辦理「全科醫師養成訓練計畫」，隨後1979年臺大醫院成立一般科住院醫師訓練計畫。1985年衛生署訂定「補助醫學院與教學醫院辦理家庭醫師訓練」計畫與1986年3月1日中華民國家庭醫學醫學會成立，讓台灣家庭醫學專科醫師訓練制度有了良好的開始，同年5至6月家庭醫學醫學會接受衛生署委託，辦理第一次家庭醫學科住院醫師訓練計劃評鑑計畫。1987年開始辦理家庭醫學科專科醫師甄審及家庭醫學科專科醫師訓練醫院認定工作，為台灣第一個接受官方委託辦理前述業務之專科醫學會。台灣家庭醫學專科訓練醫院評鑑相關的兩大文件為「家庭醫學科專科醫師訓練課程基準」及「家庭醫學科專科醫師訓練計畫認定基準」。前述訓練課程基準留有相當的選修空間，各計畫可依本身特色作彈性設計。另PGY一般醫學訓練課程與家庭醫學專科訓練課程同屬不同階段與層次的學習，兩者相輔相成，並不互相衝突。2013年台灣家庭醫學醫學會提供「家庭醫學科住院醫師訓練核心課程學習歷程」參考指引供各訓練醫院參考，該指引內容包括家庭醫學核心課程(core concept of Family Medicine)、疾病與症候群(disease and syndrome)、核心技能(core skills)、主訴／症狀／徵候(chief complaint/symptom/sign)四大部分；各訓練計畫可依該指引內容為核心，調整學習內容，有利於家庭醫學之多元發展。過去三十年來，台灣家庭醫學專科住院醫師訓練課程與認定已有很好的基礎，未來如何強化住院醫師的核心能力、擴展指導教師的教學熱忱與技能、改善訓練醫院的教學品質、改進訓練醫院的認定制度，並與社會民眾醫療照護/社會照顧的需求互相結合，全面提升家庭醫學科專科醫師訓練的水準，進而訓練出符合社會需求的優秀家庭醫學科專科醫師，期能提供民眾以病人為中心的優質全人醫療照護服務。

A competent family physician comes from a solid training curriculum based on the six core competencies of the Accreditation Council for Graduate Medical Education and built on the belief in holistic health care that encompasses individual, family, and community. In Taiwan, the training of family medicine began with the government-funded fostering program of general practitioners in 1976. National Taiwan University Hospital initiated the training program of general practitioners, the prototype of Taiwan’s family medicine training system, in 1979. The Association of Family Medicine, ROC, was then established in 1986 as the first institute entrusted by the government to implement family medicine specialty certification examination and residency training program accreditation. In 2013, the Residency Review Committee was organized by government to assess and approve the accreditation processes conducted by medical specialist societies for the evaluation of their residency training programs. The article incorporated three major sections. The first covered the origin and the official basis of the accreditation of family medicine residency programs in Taiwan. The second dwelled on the core and the flexibility of the family medicine residency curriculum based on the requirement of Residency Review Committee. The final section focused on the development trend of family medicine residency programs and curricula. An example about the trend of family medicine as a subspecialty in Canada was introduced. The competency-based developmental outcomes, such as milestones and entrustable professional activities, were also provided.