醫學生倫理素養之提昇：以三國演義課程為例

Elevating Ethic Literacy of Medical Undergraduates – Taking the Course of “Romance of the Three Kingdoms” as an Example

醫療情境漸趨複雜，醫病關係日益緊張，醫學相關科系學生的專業倫理也愈受重視。如何透過通識教育提升學生基本倫理素養值得探究。三國演義傳達忠孝節義故事，為倫理教育的重要素材，然而通識課程能否有效提昇倫理素養卻缺乏探討。教師透過三國故事引發課程討論，使學生學習人際互動基本態度，進而延伸至現代生活及醫療倫理情境，並藉反思日誌增進學生自我察覺、問題解決與批判思考能力。本研究以臺北醫學大學102學年第1學期修習通識課程三國演義的37名大學生為研究對象，分析學生17週的反思週誌內容，並以三國演義學習成效自評表及教務處執行的教師教學評量為工具，評估課程在倫理素養的提升功效。結果發現學生反思週誌呈現5大層面倫理素養學習，包括：1.學習良善德行；2.批判錯誤作為；3.思辨兩難困境；4.提升自身格調；5.履行道德實踐。量化結果顯示，學習成效自評表20個題項中與倫理相關的兩題是評量最低的第2、3項；惟20個自評題目的平均得分都在4.32以上（5點量表），且教師教學評量中學生自評學習成效達4.58。日後課程可再加強同儕互動，將實踐倫理素養設定為課程核心目標，並採用具信、效度的前、後測評估工具，以進一步驗證倫理素養的提昇。

Medical context becomes more and more complicated in recent years, and the relationships between physicians and patients are with a lot of tensions. Ethic literacy is emphasized in medical universities, and it is worth exploring how to improve basic ethics through general education course. Depicted stories of loyalty, filial piety, chastity, and righteousness, Romance of the Three Kingdoms could be major material to elevate ethic literacy. However, it lacks exploration to evaluate the effectiveness on how to improve undergraduates’ ethical literacy. The lecturer, as a facilitator in the class, initiated students to discuss ethic issues through stories to realize the essential attitude of interpersonal relationship, and modern life and medical ethic situations were also discussed in advance to get more self-awareness, learn how to solve problems, and familiarize with critical thinking through writing reflection journal. The present study was based on the classic reading course at TaipeiMedicalUniversity during 2013 autumn semester, and the reflection journals of 17 weeks from 37 students, the self-rating learning questionnaire, and teaching performance rating executed by Office of Academic Affairs were analyzed to evaluate the effectiveness on elevating ethical literacy. Results showed 5 aspects of ethic literacy elevating: 1. To learn good virtue; 2. To criticize mistakes; 3. To differentiate and contemplate dilemma situations; 4. To elevate personal moral level; 5. To put morality into action. Quantitative data showed that two self-rating items related to ethics literacy were low instead. In general, the averages of the 20 items of self-rating learning questionnaire were above 4.32, and the teaching performance rating on learning effectiveness rated by students themselves were above 4.58, so that the overall improvement was approved. In the future, the element of peer interactions could be added, and the ethical literacy should become the main goal of the course. By adapting assessment tools with better reliability and validity tested before and after the course, the elevating of ethical literacy would be further affirmed.