COVID-19疫情對醫學生臨床訓練的影響：對Disease X準備的啟示

Impact of the COVID-19 pandemic on medical students’clinical training：lessons for preparing for Disease X

目標：本研究旨在探討新興傳染疾病（Disease X）即COVID-19疫情對醫學生臨床訓練的影響，特別針對OSCE(Objective Structured Clinical Examination, OSCE)臨床能力表現與對學習環境的感知。方法：採橫斷式研究設計，納入疫情前（2019世代）與疫情中（2020世代）兩組醫學生的臨床訓練資料進行分析比較。研究工具包含Dundee醫學教育環境量表（Dundee Ready Education Environment Measure, DREEM）及客觀結構式臨床技能測驗（OSCE），使用描述性統計、t檢定、皮爾森相關及多元線性迴歸分析。結果：本研究共納入322名醫學生（2019世代167人；2020世代155人），其中男性（187人）約占全體研究對象之六成（58.1%）。兩組之DREEM分數無顯著差異，且與OSCE分數無顯著相關。然而，2020世代在OSCE標準化病人模擬情境測驗的總分，顯著低於2019世代。性別分析顯示，2020世代女性學生在DREEM與OSCE表現均顯著下降，男性則僅在OSCE分數降低。迴歸分析亦確認疫情中世代OSCE成績顯著下滑。結論：新興傳染疾病疫情期間，醫學生OSCE臨床能力普遍下降，女性學生對臨床學習環境的正向感受亦低於疫情前世代。研究結果可為公共衛生體系在未來疫情中參與制定精準醫學教育策略提供依據，並凸顯維持臨床訓練韌性對新興傳染病疫情的必要性。

Objectives: The coronavirus disease 2019 (COVID-19) pandemic disrupted medical education worldwide, especially limiting real-word clinical experiences and direct patient interactions which are crucial to medical skill development. This study examined how this disease X pandemic affected clinical training for medical undergraduates. Methods: This cross-sectional study included participants from a prepandemic (Cohort 2019) and a midpandemic (Cohort 2020) cohort. Descriptive statistics, t-tests, Pearson correlation, and multiple linear regressions were conducted to examined the condition differences between the cohorts. Results: A total of 322 students were recruited, including 167 from Cohort 2019 and 155 from Cohort 2020; 187 participants (58.1%) were male. Subjective perceptions of the clinical learning environment were assessed using the Dundee Ready Educational Environment Measure (DREEM), while objective clinical competencies were evaluated using the Objective Structured Clinical Examination (OSCE). Our results showed neither significant differences in DREEM scores between the cohorts, nor significant correlation between DREEM and OSCE scores. OSCE scores were significantly lower in Cohort 2020 than in Cohort 2019. Female students in Cohort 2020 reported lower DREEM perceptions and OSCE performance, while male students mainly showed decreased OSCE scores only. Multiple linear regression analyses also confirmed significant reductions in OSCE scores in Cohort 2020. Conclusions: During the disease X pandemic, female students reported lower positive perceptions of the clinical learning environment, and all students trained during the pandemic period demonstrated lower OSCE clinical competencies compared with the pre-pandemic cohort. Our evidence could not only provide public health systems to prepare targeted strategies for future disease X, but also highlight the need to ensure resilience in clinical training.