社區醫學訓練與試辦偏遠衛生所訓練計畫調查

Questionnaire for Community Medicine Training in Family Medicine Training Program and Rural Health Center Training Program

目的：根據衛生福利部調查醫療區域醫師人力密度，部份次醫療區域醫師人力仍低於世界衛生組織所定最低醫療基本需求之每萬人口醫師數10位，因此衛生福利部提出優化偏鄉醫療精進計畫，其中教育方面規範家庭醫學科於專科訓練期間得前往偏遠地區衛生所進行輪訓。為完善規劃偏遠衛生所輪訓試辦之事宜，因此進行本研究。

方法：於2020年6月對全台68所符合家庭醫學科訓練資格醫院之部科主任或家庭醫學專科醫師訓練計畫主持人行問卷調查，後續召集有參加試辦計畫意願之醫療院所進行會談與二次調查。

結果：問卷回收率100%。全台約60.3%之教學訓練醫院有大於一個月以上的衛生所訓練計畫，且大部分的訓練醫院同意衛生所是具備教學功能之院外基層醫療訓練場所。然而安排偏遠地區衛生所訓練的主要障礙是工作分配困難與和不符合醫院組織的方向與需求，此外工作場所安全、學習和工作間的平衡也是一大考量。儘管如此，多數醫院仍認為偏遠地區衛生所之訓練能有助住院醫師的責任感訓練及不同制度下之工作與溝通訓練。

結論：此計畫執行立意良善，然衛福部需考慮增加家庭醫學科總訓練容額、補助交通經費、補助相關保險、偏遠執業風險及教學訓練之平衡。以期於住院醫師訓練、醫療院所家庭醫學科成長及國家偏遠醫療精進之間達成多贏局面。

 

Purpose: According to a MOHW (the Ministry of Health and Welfare) survey, several sub-regions (mainly rural and remote areas) in Taiwan fail to meet the WHO minimum requirement for health workforce (ten physicians per ten thousands residents). The MOHW had accordingly developed and implemented a program requiring all family medicine doctors-in-training to spend a part of their residency at rural health centers (RHCs). To promote the quality and efficacy of the training program and the safety of the training environment, the following research was conducted.

Methods: A questionnaire was issued in June 2020 to the branch chiefs and training program organizers of the 68 hospitals qualified for family medicine training in Taiwan. A symposium was subsequently held and a survey conducted to learn and analyze the responses of all the participating hospitals and public health centers.

Results: The response rate of the questionnaire was 100%. Around 63% of the responding hospitals had a RHC training program more than one month long, and most of the hospitals found public health center a good training venue. A major difficulty was that sending residents specializing in family medicine to RHCs seldom met the needs and goals of those hospitals. In addition, safety of the working environment and balance between learning and working were identified as issues demanding further consideration. Nevertheless, most participating hospitals believed that training at RHCs did help promote residents’ sense of responsibility, as well as their ability to work under different systems.

Discussion: The program has great humanitarian potential. However, the MOHW may need to consider increasing the allowed number of trainees in family medicine each year, subsidizing trainee’s travel and insurance expenses, and assessing and addressing the risks of practicing in remote and rural areas so both the quality and efficacy of the training program can be improved to create win-win outcomes for all parties involved.