從評鑑看臺灣醫學人文教育現況之分析

An Accreditation-Based Analysis of Medical Humanities Education in Taiwan

醫學人文為結合醫學與人文社會科學之跨學科領域，強調從病人主體經驗、倫理判斷與醫病關係理解醫療實踐，亦是培育醫師專業認同與全人照護能力的重要基礎。臺灣自1990年代起，在政策推動與臺灣醫學院評鑑委員會（TMAC）制度影響下，逐步推進醫學人文教育之制度化，各醫學院校亦陸續發展相關課程並強調整合。然而，現行醫學人文教育仍面臨若干問題，亦缺乏系統性分析。基此，本研究將針對TMAC實地訪視之全面訪視報告進行系統性分析，探討臺灣醫學院校醫學人文課程規劃、教學評量與師資配置之現況、差異與潛在困境，並提出具體建議。
本研究以2022至2023年接受TMAC實地訪視之11份醫學系全面訪視報告為主要資料，輔以各系課程地圖，採導向式內容分析（DCA），並以2020年TMAC評鑑準則作為演繹分析框架，系統檢視醫學人文教育相關內容，並進一步分析未能納入既有框架之資料，以掌握潛在結構性議題。
研究結果顯示，多數學校已建立醫學人文課程架構，涵蓋倫理、法律與醫病溝通等核心內容，並導入問題導向學習、敘事醫學與反思寫作等多元教學策略。然而，課程多集中於低年級，與臨床實習缺乏縱向銜接，橫向整合亦不足；評量方面普遍存在評分標準不明、質性回饋不足及鑑別度有限等問題；師資則以臨床教師為主，人文社會背景教師參與不足，且評鑑準則判定亦存在一致性差異。
我們的研究進一步發現，台灣的醫學人文教育不僅在課程設計、評量方式和師資培育等層面遇到實務挑戰，更反映其存在結構性的困難，例如，課程工具化傾向、制度誘因不足、人文師資發展受限於生物醫學導向之升遷體制，以及評鑑準則詮釋上的不明確性。據此，未來除持續精進課程整合、學習評量與師資培育外，還應積極建立跨校資源共享和區域交流平台，並加強醫學人文教育與國家考試、PGY訓練、及醫療照護系統的連結，以避免醫學人文教育在醫療照護體系被邊緣化的處境。

Medical humanities is an interdisciplinary field that integrates medicine with the humanities and social sciences. It emphasizes patients’lived experiences, ethical judgment, and doctor–patient relationships, and is fundamental to physicians’professional identity formation and holistic care. Since the 1990s, medical humanities education in Taiwan has been gradually institutionalized through policy initiatives and the influence of the Taiwan Medical Accreditation Council (TMAC). However, it still faces several challenges and lacks systematic analysis. This study systematically analyzes TMAC comprehensive site visit reports to examine the current status, variation, and potential difficulties in curriculum design, assessment, and faculty allocation in medical humanities education across Taiwanese medical schools, and to propose specific recommendations.
This study analyzed 11 comprehensive TMAC accreditation site-visit reports (2022–2023), supplemented by curriculum maps, using directed content analysis (DCA) with the 2020 TMAC accreditation standards as the deductive framework. Data that fell outside this framework were further examined to identify structural issues.
The findings indicate that most schools have established foundational curricula and adopted diverse pedagogical approaches. However, curricula remain concentrated in preclinical years, with limited vertical integration into clinical training and fragmented horizontal connections. Assessment practices often lack clear criteria, provide limited qualitative feedback, and demonstrate limited discrimination. Faculty composition is predominantly clinically oriented, with limited participation from humanities and social science scholars. Inconsistencies are also observed in the interpretation of accreditation standards.
Further analysis suggests that these issues reflect not only practical challenges in curriculum, assessment, and faculty development, but also deeper structural constraints, including the instrumentalization of medical humanities, weak institutional incentives, promotion systems shaped by biomedical priorities, and ambiguities in the interpretation of accreditation standards. Considering these findings, future efforts should extend beyond the continued refinement of curriculum integration, learning assessment, and faculty development to include the proactive