以紮根理論探索醫學生批判思考能力的建構

Exploring the Construction of Critical Thinking Skill with Grounded Theory for Medical Students

「臨床推理」是醫學專業養成的核心技能，為醫學教育目標之一。此能力的培養，除需豐富的知識累積並持續更新之外，更需要較長的學習歷程才得以精進。而「批判性思考」是「臨床推理」之根本，具備良好批判性思考能力者，其臨床實境之決策、解決問題以及專業能力表現相對較佳。故本研究目的在於藉由所開設之四門技能本位課程，透過深度訪談不同選修課程數目的學生，針對「批判思考」與「臨床推理」技能之建構，應用紮根理論將資料蒐集加以彙整後，進行質性研究，藉以了解醫學生批判性思考的運用模式，以利後續臨床教學之目標制定與改進方向之參考。
研究結果顯示，透過質性訪談資料分析，批判性思考技能的建構需要一定歷程與時序，並對於臨床能力表現具顯著的影響力。另外，選修課程的學生多肯定本研究所開設課程的上課模式，除能強化批判性思考技能之外，亦可累積多元案例探討經驗與演練機會；更同時感知醫師診治病人之思考路徑及臨床推理過程，均有助於臨床技能的提升，並與臨床見習之床邊學習順利接軌。因此，本研究能夠提供一個有效的技能訓練參考模板，供未來臨床教學教師課程設計之參考。

Clinical reasoning is a core skill developed in medical professional training and is an objective of medical education. Cultivating clinical reasoning not only requires a wealth of accumulated and continually updated knowledge but also needs a prolonged learning process for refinement. Critical thinking is fundamental to clinical reasoning; individuals with strong critical thinking skills tend to perform better in clinical decision-making, problem-solving, and overall professional competence. Therefore, this study aimed to utilize a skills-based curriculum across four modules to conduct in-depth interviews with students who have taken varying numbers of elective courses. Using grounded theory, we collected and analyzed data to understand how medical students apply critical thinking and construct clinical reasoning skills. This qualitative research seeks to inform the development of clinical teaching objectives and improvement directions.
The findings indicate that the construction of critical thinking skills requires a certain process and timeline to significantly impact clinical performance. Students in elective courses generally appreciate the course format, which not only enhances critical thinking skills but also provides opportunities for exploring diverse case studies and practical exercises. They also perceive benefits in understanding the thought processes of physicians in diagnosing patients and the clinical reasoning process, which aids in improving clinical skills and smoothly integrates with bedside learning during clinical rotations. Thus, this study provides an effective template for skills training that can serve as a reference for future clinical educators in designing courses.