從美國家庭醫學里程碑計畫探討台灣家庭醫學科住院醫師里程碑之關鍵評估項目：模糊德懷術之應用

Identifying the Key Evaluation Items of the ACGME Family Medicine Milestone for Residency Training in Taiwan: A Fuzzy Delphi Study

目的：2015年美國家庭醫學學習里程碑計畫「The Family Medicine Milestone Project」是針對家庭醫學科住院醫師從開始訓練到完成之不同訓練階段之描述與目標的發展架構，本研究以其為基礎，探討台灣家庭醫學科住院醫師學習里程碑之關鍵評估項目，作為推展能力取向之醫學教育模式的參考。

方法：參照美國家庭醫學學習里程碑計畫包含六大核心能力，每大項核心能力各有其次能力(sub-competency)，共計有22項次能力，每項次能力皆有五個等級(level)，每個等級各有其不等個數的評估項目共225個里程碑，經深度訪談與工作小組專家會議修訂發展成263個里程碑之模糊德懷術問卷。本研究計有40位男性主治醫師與29位女性主治醫師參與本次模糊德懷術問卷，透過隨機分配為三組，每組分別針對六大核心能力之其中兩項，就核心能力中之各項次能力里程碑各等級評估項目的重要性進行探討，以選取學習里程碑中的關鍵評估項目，最後透過工作小組專家會議討論與確認關鍵項目。

結果：本研究計有69位醫師參與，64位醫師完成有效專家問卷，其中20位參與病人照護力與知識思辨力兩大核心能力之項目，21位參與專業素養力與學習成長力兩項，23位參與人際溝通力與系統融入力兩項。從263項評估項目中，經過最大最小法之推估重要性後，遇分數相等之項目，於工作小組專家會議討論，最後選取22項次能力之各等級110個關鍵的評估項目。

結論：此六大核心能力相關之里程碑關鍵評估項目可作為發展家庭醫學科住院醫師專科訓練以能力為取向之優先學習與評估的重點參考。

 

Purpose: In 2015, the Accreditation Council for Graduate Medical Education and the American Board of Family Medicine jointly initiated the Family Medicine Milestone Project aiming to establish a milestone-based framework for assessing the competencies of family medicine residents at various levels from beginner to professional. Based on the project’s core concept of competency-based medical education, the present study explored the key milestones of family medicine resident training in Taiwan.

Method: The project assessed six core competencies consisting 22 sub-competencies with each sub-competency incorporating five levels and each level including 1–3 items, leading to a total of 263 items in the fuzzy Delphi questionnaire. An expert meeting composed of 40 male and 29 female family physicians was organized. Through random allocation, participants were divided into three groups, and two core competencies were surveyed per group through expert judgment using the fuzzy Delphi method.

Result: Of the 64 physicians completing effective questionnaires, 20 were assessed for their competencies of patient care and medical knowledge, 21 for competencies of professionalism and practice-based learning and improvement, and 23 for competencies of systems-based practice and interpersonal and communication skills. After questionnaire data were compiled and the importance of all items for their corresponding levels estimated by the max–min method, 263 items were identified. One key item was then selected for each level, resulting in the emergence of 110 key items.

Conclusion: With the core concepts drawn from the professional growth process, a five-level learning map with 22 professional sub-competencies of the six core competencies was constructed. This 110-item evaluation form can be used in conjunction with the constructed learning map for the evaluation of family medicine residents in order to promote competency-based medical education.