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系統識別號 U0007-0807201315564700
論文名稱(中文) 安寧緩和醫療教育課程對醫學生知識與態度之影響: 從2007到2011年某醫學院之調查研究
論文名稱(英文) The influence from palliative care education on the knowledge and attitude of medical students: a medical school survey from 2007 to 2011
校院名稱 臺北醫學大學
系所名稱(中) 醫學人文研究所
系所名稱(英) Graduate Institute of Humanities in Medicine
學年度 101
學期 2
出版年 102
研究生(中文) 林晏群
研究生(英文) Yen-Chun Lin
電子信箱 linyanchun527@hotmail.com
學號 M716100002
學位類別 碩士
語文別 中文
口試日期 2013-05-24
論文頁數 110頁
口試委員 指導教授-蔡篤堅
共同指導教授-胡文郁
委員-邱泰源
委員-賴允亮
委員-邱仲峰
中文關鍵字 安寧緩和醫療  醫學教育  追蹤研究 
英文關鍵字 palliative/hospice care  medical education  follow-up study 
學科別分類
中文摘要 安寧緩和醫療是照護末期生命最重要的選項,醫學教育近十年逐漸增加安寧緩和醫療課程,也致力於評量醫學院學生對於末期照護的知識、態度和臨床技能。對此有助於觀念推廣,精緻醫護人員素質與知能,對於改善末期照護品質有很大的幫助,且進一步發展成臨床教學指引與成果評量的依據。而目前多數的文獻皆是對單一課程成效的論述,就課程短期成效而言,發表者皆有顯著性的成效,但對於長時間學習成效的追蹤研究仍相當匱乏。
本研究旨在瞭解醫學系學生與畢業生對於安寧緩和醫療知識及安寧緩和醫療倫理情境態度改變、及探討影響這些有機會接受安寧教育和相關訓練的新生代醫師們對安寧緩和醫療知識與安寧緩和醫療倫理情境態度改變之相關因素,以及這些改變與末期照顧臨床能力之相關性。為描述性縱貫式調查研究(longitudinal survey),以結構性問卷(structured questionnaires)收集資料,採取方便立意取樣方式聯繫北部某醫學大學之醫學生與畢業生,共回收有效問卷共138份。研究工具包括:醫學生緩和醫療認知問卷、末期照護臨床能力自評量表及課程評估量表。以SPSS16.0建立資料與統計分析。
本研究重要結果如下:1.這些新生代醫師與準醫師們安寧緩和醫療知識答對率比較醫五課程後測成績,雖有下降但無達到顯著;2.他們安寧緩和醫療倫理態度分數較醫五後測分數高,表示安寧緩和醫療醫學教育有其延續性;3.影響其知識及倫理態度改變與少部分社會人口學變項及學習經驗有顯著差異;4.倫理態度之改變與末期照顧臨床能力有顯著正向相關。
結論為醫學系學生與畢業生之安寧緩和醫療知識、倫理態度,可透過繼續教育與經驗務實的臨床體驗,延續及維持在醫學院教育所培育的安寧緩和醫療知識及態度,其中末期照顧經驗扮演非常關鍵性的角色。
英文摘要 Palliative/hospice care has been considered the most appropriate model of care for terminal patients, and medical education concerning palliative/hospice care has been increasing in the last three decades, that medical students should learn palliative/hospice care has been incorporated into the curriculum. Assessment of medical students in terms of their palliative/hospice care knowledge, attitudes and clinical skills will not only help to improve the quality of end-of-life care, but should also be included in the guidelines of teaching outcomes in medical schools. However, most of the literature and research projects discuss only the effectiveness of short-term training courses.
The study reported in this thesis located 138 medical students, graduate medical students, and medical residents, who had completed a one-day palliative/hospice medicine course in their fifth year in medical school, and asked them to complete a follow-up questionnaire. The main goal of this research was: (1) what is the palliative/hospice knowledge and ethical attitudes changed; (2) what are the factors that lead to change medical students in the palliative/hospice care knowledge and attitudes; (3) what is the relationship between the palliative/hospice care knowledge and attitudes of the students, and their clinical competence in end-of-life care?
The study results showed that: (1) Medical students rating on palliative/hospice care knowledge has decreased over this time, but it is not statistically significant; (2) their ethical attitude score was higher than their one-day training post-test scores, which means that the palliative/hospice care education has achieved; (3) the change in knowledge and ethical attitudes significantly related to a small number of social-demographic variables and learning experiences, such as internship and service learning; (4) the change in ethical attitudes was significant positive correlation with clinical competency of end-of-life care.
In conclusion, this study indicates that education in palliative/hospice care for medical students will maintain their palliative/hospice care knowledge and ethical attitudes, and enhance their clinical competence of end-of-life care.
論文目次 謝 辭……………………………………………………………………………I
中文摘要……………………………………………………………………………II
英文摘要……………………………………………………………………………III
目 錄……………………………………………………………………………IV
表 目 錄……………………………………………………………………………VI
附 錄……………………………………………………………………………VII
第一章 緒論………………………………………………………………………1
第一節 研究背景與動機……………………………………………………1
第二節 研究問題……………………………………………………………5
第三節 研究目的……………………………………………………………6
第四節 名詞界定……………………………………………………………7
第二章 文獻查證…………………………………………………………………8
第一節 安寧緩和醫學教育發展……………………………………………8
第二節 國內外安寧緩和課程內容及成效…………………………………12
第三節 安寧緩和醫學體驗學習……………………………………………20
第四節 課程追蹤性研究……………………………………………………22
第五節 安寧緩和醫學教育早期探索性學校課程…………………………26
第三章 研究方法…………………………………………………………………28
第一節 研究設計……………………………………………………………28
第二節 研究架構……………………………………………………………28
第三節 研究對象……………………………………………………………29
第四節 研究工具……………………………………………………………29
第五節 資料收集過程………………………………………………………32
第六節 課程介紹……………………………………………………………32
第七節 資料分析方法………………………………………………………33
第八節 研究倫理考量………………………………………………………33
第四章 研究結果…………………………………………………………………34
第一節 醫學(畢業)生安寧緩和醫療知識、倫理態度與臨床能力情形…34
4.1.1 基本資料…………………………………………………………34
4.1.2 安寧緩和醫療知識答對率情形…………………………………35
4.1.3 安寧緩和醫療倫理態度情形……………………………………36
4.1.4 自評末期照顧臨床能力…………………………………………37
第二節 醫學(畢業)生安寧緩和醫療知識與倫理態度改變情形…………50
4.2.1 醫學(畢業)生安寧緩和醫療知識答對率比較…………………50
4.2.2 醫學(畢業)生安寧緩和醫療倫理態度比較……………………52
第三節 醫學(畢業)生安寧緩和醫療知識與安寧緩和醫療倫理態度改變因子………………………………………………………………54
4.3.1 影響安寧緩和醫療知識題改變之因素…………………………54
4.3.2 影響安寧緩和醫療倫理情境態度改變之因素…………………57
4.3.3 基本屬性、臨床學習經驗及過去經驗對安寧緩和醫療知識顯著改變之因子………………………………………………………60
4.3.4 基本屬性、臨床學習經驗及過去經驗對安寧緩和醫療倫理態度顯著改變之因子…………………………………………………63
第四節 醫學(畢業)生安寧緩和醫療知識與安寧緩和醫療倫理態度與末期照護能力相關性…………………………………………………66
第五節 醫學(畢業)生對安寧緩和醫療系列課程之期待及建議…………73
第五章 討論………………………………………………………………………77
第一節 醫學(畢業)生安寧緩和醫療知識的改變探討……………………77
第二節 醫學(畢業)生安寧緩和醫療倫理態度的改變探討………………80
第三節 影響醫學(畢業)生安寧緩和醫療知識與倫理態度的因素探討…83
第四節 醫學(畢業)生安寧緩和醫療知識與倫理態度改變與其臨床照護能力的探討…………………………………………………………85
第五節 醫學(畢業)生對安寧緩和醫療系列課程之反饋…………………87
第六章 結論與建議………………………………………………………………91
第一節 結論…………………………………………………………………91
第二節 醫學教育應用………………………………………………………93
6.2.1 醫學教育方面……………………………………………………93
6.2.2 臨床實務方面……………………………………………………93
第三節 研究限制與未來研究之建議………………………………………94
參考文獻……………………………………………………………………………95
附 錄……………………………………………………………………………101
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