臺灣博碩士論文加值系統

研究目的：有鑑於近年來神經科疾病在診斷與治療上的迅速進步。本研究希望能重新審視神經科實習醫學生的核心神經學檢查項目，並比較不同背景成員間評分觀點之差異。
研究方法：本研究先採用LINE群體討論，針對神經科實習醫學生設計出所應包含的核心神經學檢查項目清單，以作為後續的兩回合網路德菲法研究的項目。其次，本研究採用網路德菲法，是使用Survey Monkey網路軟體，邀請30位不同背景的成員，包含教師與學員、神經科與非神經科醫師、社區醫院與醫學中心專家醫師、以及不同職級的教師在網路上進行匿名討論。所有成員以九級分立克式量表，評價每一項神經學檢查項目是否應納入實習醫學生的核心學習項目，鼓勵每位成員提供回饋。此外，本研究也以Mann-Whitney U檢定比較不同背景成員間評分觀點之差異。
研究結果：起初共有83項神經學檢查項次提供給30位成員進行首回的德菲法研究，有18項沒有得到充分的共識。這些未獲共識的18項目，連同14項在首回中成員所建議新納入的神經學檢查項目，都在第二回德菲法中進行討論。最終，共有75項被評定為神經科實習醫學生應具備的核心神經學檢查項目。
研究結論：本研究提供了在神經學里程碑中，神經科實習醫學生階段所應具備的核心神經學檢查項目教學依據。期望這發現有助於減輕醫學生在學習神經學檢查上所遭遇的困難與焦慮。

Background: With the evolution of treatments in neurological diseases, the contents of complete neurological examination (NE) for medical students may need to be modified. This study aimed to establish a consensus on the core NE items for neurology clerks and compare the viewpoints between different groups of panelists.
Methods: First, the pilot group in this study generated a list of proposed core NE for neurology clerks. The proposed core NE items were provided for a two-round modified web-based online Delphi process, using the online software, “SurveyMonkey.” A total of 30 panelists from different backgrounds participated in the modified Delphi process (i.e., tutors or learners, neurologists or non-neurologists, community hospital or medical centers, and different academic positions). Each panelist was asked to agree or disagree on each item’s inclusion, using a 9-point Likert scale. We encouraged the panelists to provide feedback, and compared the panelists’ viewpoints using Mann-Whitney U tests.
Results: A total of 83 items were initially provided for the first round modified Delphi process, of which, 18 items without consensus and another 14 added items suggested by the panelists in the first round were further discussed in the second round. Finally, a total of 75 items were included in the recommended core NE items during neurology clerkship.
Conclusions: This study provided a reference regarding the core NE items corresponding to the milestone of neurology clerkship. Hopefully, the results can minimize the content, complexity, and anxiety of learning NE for medical students.

RECOMMENDATION LETTER FROM THE THESIS ADVISOR……
THESIS/DISSERTATION ORAL DEFENSE COMMITTEE CERTIFICATION……………………………………………………….
ACKNOWLEDGEMENTS...……………………………………………iii
CHINESE ABSTRACT..……………………………………..……….…iv
ENGLISH ABSTRACT.………………………………………….………v
TABLE OF CONTENTS...…………………………………...………….vi
LIST OF TABLES………………………………………………...…......ix
LIST OF FIGURES..………………………………………...……….…..x
CHAPTER 1 BACKGROUND…..………………………………………1
1.1 Introduction………………………………………..……………….1
1.2 Purpose of the study………………..………………………………1
CHAPTER 2 REVIEW OF THE LITERATURE…………………..…....2
2.1 The neurology clerkship……………….………………………..….2
2.2 Current state of neurological education……………………...…….2
2.3 Neurophobia……………………………………….…………….…3
2.4 Neurological examination…………………………….…...……….4
2.5 Milestone development and entrustable professional activities........5
2.6 The Taba model………………………………………….…………6
CHAPTER 3 METHODS……………………………...…………………7
3.1 Study design………………………………………………………..7
3.2 Participants and setting…………………..………………………...7
3.2.1 The pilot group………………………………………………...7
3.2.2 The panelists of the modified Delphi process……..………......9

3.3 The survey tools……………………………………..…...……….11
3.3.1 The tool used in pilot group discussion: LINE……………….11
3.3.2 The tool used in modified Delphi method: SurveyMonkey….11
3.4 The modified web-based online Delphi method………….............12
3.4.1 Background surveys………………………………………….12
3.4.2 The first round ……………………………………………….12
3.4.3 The second round…………………………………....……….13
3.4.4 Feedback……………………………………………………..14
3.5 Data collection……………………………………….…...............14
3.6 Data analysis……………………………………….......................15
3.7 Ethical consideration……………………………………..…….…15
CHAPTER 4 RESULTS………………………………………...............16
4.1 Background characteristics of the panelists……………................16
4.2 The proposed core neurological examination items for the neurology clerks from the pilot group…………...……….............16
4.3 Results of the first round modified Delphi process………………21
4.4 Results of the second round modified Delphi process…................22
4.5 Difference of the viewpoints between the panelists with diverse backgrounds………………………………….…………….….….26
4.5.1 Tutors vs. learners………………………………………..…...26
4.5.2 Neurologists vs. non-neurologists…………………….…..….26
4.5.3 Experts in medical center vs. others…………………….……27
CHAPTER 5 DISCUSSION………………………………………..…...30
5.1 General ratings………........……………………………………....30
5.2 Difference between our results and previous studies…………......31
5.3 Physical examinations………………………………….................32
5.4 Conscious and cognitive functions…………………………….…33
5.5 Cranial nerves……………………………………………….……33
5.6 Motor, sensation, and reflexes………………………….………...34
5.7 Functions of cerebellar and extrapyramidal systems, gait and station…………………………………………………………......35
5.8 Autonomic system and others…………………………….…..…..36
5.9 Advantage and disadvantage of our web-based modified Delphi method…………………………………………...…..…....36
5.10 Limitations……………………………………………................38
CHAPTER 6 CONCLUSIONS…………………………………..……..40
REFERENCES………………………………………………………….41
APPENDIX 1. ITEMS OF NEUROLOGICAL EXAMINATIONS INITIALLY PROVIDED FOR THE PILOT GROUP…48
APPENDIX 2. RESULTS OF THE FIRST ROUND MODIFIED
DELPHI PROCESS……………………………..….….53
APPENDIX 3. RESULTS OF THE SECOND ROUND MODIFIED
DELPHI PROCESS........................................................59
 
LIST OF TABLES
Table Page
3-1 Delphi: Flow chart…………………………………………...…...….8
3-2 The composition of the members in the panelist group……...……..10
3-3 Selecting criteria of the enrolled panelists…………………...……..10
4-1 Background characteristics of the panelists…………….…………..17
4-2 List of proposed core neurological examination items for the modified Delphi process………………………………………….....19
4-3 Results of modified Delphi process……………………….………..24
4-4 Difference of the viewpoints between the panelists with diverse backgrounds…………………………………………………..……..28
 
LIST OF FIGURES
Figure Page
3-1. The decision-making process of the modified Delphi rounds...........14
4-1. Results of the pilot group and modified Delphi process……...........22

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