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研究生:王巍穆
研究生(外文):Wei-Mu Wang
論文名稱:台灣地區年輕牙醫師接受住院醫師訓練之現況及相關因素
論文名稱(外文):Current Resident Training Background and Associated Factors for Young Dentists in Taiwan
指導教授:季麟揚季麟揚引用關係
指導教授(外文):Lin-Yang Chi
學位類別:碩士
校院名稱:國立陽明大學
系所名稱:臨床牙醫學研究所
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:2006
畢業學年度:94
語文別:中文
論文頁數:110
中文關鍵詞:年輕牙醫師牙科住院醫師訓練住院醫師離職意願畢業後再進修全民健保接受住院訓練動機
外文關鍵詞:young dentistspostgraduate dental resident trainingresignation of residentpostgraduate educationnational health insurancemotivation of accepting training
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本研究之焦點為台灣地區醫院牙科住院醫師訓練,是因為全民健保實施十一年以來,雖然民眾的滿意度提高許多,亦減少了民眾就醫時的財務障礙,但同時有許多醫院牙科漸漸招收不到牙科住院醫師,而且訓練期間亦常出現中斷的情形。然而目前針對牙科住院醫師的調查並不多見,亦無法得知牙科門診總額實施之後對於剛畢業的年輕牙醫師接受住院訓練產生何種程度的影響。
本研究以問卷訪查區域醫院等級以上的牙科住院醫師,共發出412份問卷,回收有效問卷285份,回收率為69.4%。信度分析之cronbach’s alpha係數大致在0.6以上。結果如下:男性與女性的比例是52%:48%;平均年齡男性為29歲,女性為27歲。受訪者的最高學歷以牙醫學士為主(91.4%)。住院訓練第一、二年(R1R2)佔66.1%,訓練第三至五年(R3R5)佔31.8%。在資深的住院醫師族群裡,又以第一類醫院的住院醫師所佔比例較高(38.1%)。住院醫師之在校成績排名自評為前1/3的佔40.8%;中1/3的佔47.8%;後1/3的佔11.4%;第一類醫院的住院醫師畢業時的成績以前1/3及中1/3為主,但是在第二、第三類醫院則以中1/3為主(P=0.002)。另外,R1R2的成績以中段者居多。
吸引年輕牙醫師接受訓練的原因,以「醫院有充分的學術資訊(60.5%)」、「為了專科訓練(55.2%)」,還有「為了完整的資歷(31.5%)」等三項因素為主。81.4%的受訪者想成為固定專科之住院醫師。成為特定專科之住院醫師理由以「成為專科醫師(60.8%)」及「學習進階學問如植牙等(52.8%)」為主。而不想之理由則以「薪水太少(50%)」及「人事環境複雜(38.5%)」為主。有20.3%的住院醫師不想參加專科訓練,其中以R1R2居多(P<0.001),原因則以「專科醫師門檻太高(66.7%)」以及「社會上還有很多專科課程(37.5%)」為主。
住院醫師每週參加教學活動的時間平均為5個小時。住院醫師的在職進修以健保不給付的項目受到較多人的青睞。計畫在未來一年內離職的住院醫師有34.7%,原因以「診所薪資比較多」有最多受訪者圈選;另外R3R5的預定離職率為48.0%,R1R2為27.0%。
本研究發現:(1)受訪的住院醫師有強烈動機希望學習學問以及磨練臨床相關技能,而且大多數受訪者經過訓練後對自己的進步感到滿意。(2)醫學中心的住院醫師有更高的期許希望能進入專科醫師領域。(3)受訪的住院醫師感受到薪資與開/執業醫師有落差,對於訓練的完整度有一定程度的影響。(4) 在校成績較佳的年輕牙醫師進入教學醫院接受住院醫師訓練的比例不如預期;但另一方面,這些成績較佳者一旦進入醫院,則繼續接受三年以上之訓練,以完成專科醫師訓練的比例也比較高。
Since the National Health Insurance (NHI) was implemented in 1995, the percentage of insured population increased from 57% to 96%, financial barriers for acquiring medical services have largely been eliminated, and the patient satisfaction rate significantly improved. However, hospitals increasingly experience difficulties recruiting residents in dental medicine. To date, there have been few studies that examined the training of dental residents in the era of global budgeting under NHI. In the present analysis, we focus on the general status and the views among dental residents currently in training.
We had mailed 412 and received 285 completed questionnaires during February to May in 2002. The response rate is 69.4%. The Cronbach’s alpha coefficient of reliability analysis of the questionnaires is greater than 0.6.
The basic characteristics of the respondents are summarized as follows. 52% are male, and the average age is 29 and 27 for male and female respondents, respectively. 91.4% of the respondents held bachelor’s degree as the highest degree obtained. 66.1% of responded residents are in their first 2 years of training (R1R2), while the remaining (38.1%) in their third to fifth years (R3R5). According to the self-reported academic performance in dental schools, 40.8% of residents graduated among the top 1/3, 47.8% among the middle 1/3, and 11.4% among the bottom 1/3 of their class. The majority of residents in ancillary medical centers of universities reported grades were in the top and middle thirds, while in the other two types of hospital, residents were more likely to report a grade ranking among the middle 1/3. The grade ranking among residents in their first 2 years of training is on average among the middle 1/3. (Delete this last sentence?)
The top three reasons for young dentists to receive postgraduate training in hospitals were: “For the higher academic learning in the hospitals (60.5%)”, ”for subspecialty training (55.2%)”, and “for more comprehensive dental training (31.5%)”. 81.4% of the residents pursue or will pursue subspecialty training and showed strong motivation. Among these respondents, the top reasons were: “aiming to become a specialist (60.8%)” and “to obtain advanced knowledge, such as dental implants (52.8%)”. Residents in medical centers expressed greater interests in pursuing dental subspecialty fields. On the other hand, those who prefer to forgo subspecialty training responded that “suboptimal salary levels (50%)” and “organizational and personnel complexities in hospitals” are their primary rationales. Overall, 20.3% of the respondents do not plan to pursue subspecialty training, most of whom (75%) in their first two years of residency.
On average, residents spend 5 hours a week on panel and case discussions, and 68% of the residents believed that the time they spend on teaching activities is sufficient.
34.7% of the residents planed to leave their current positions within the following year, and the most common reason was “better income in private dental clinics.” The expected departure rate of R3R5 was 48% and that of R1R2 was 27%
From the present analysis, we conclude that (1) surveyed residents are strongly motivated to advance their knowledge and clinical skills. Most residents were satisfied with their progress in their chosen fields. (2) Residents in medical centers expressed greater interests in pursuing dental subspecialty fields. (3) The income discrepancy between dental residents and private practitioners are of great concern among the respondents and could potentially impact their decision-making in terms of residency completion. (4) The proportion of residents in teaching hospitals who graduated with higher grades was lower than previously expected; however these individuals are more likely to complete 3 (or more) years of subspecialty training.
第一章 緒論
1.1 研究背景與目的…………………………………………… 6
第二章 文獻探討
2.1 年輕牙醫師接受住院訓練的必要性………………………… 8
2.2 我國目前的牙醫臨床訓練制度簡介………………………… 10
2.3 美國之一般臨床住院訓練與進階臨床牙醫學教育………… 11
2.4 我國健保實施前後口腔醫療支付制度之演變……………… 13
2.5 牙科醫療服務與總額支付制度……………………………… 14
2.6 我國牙醫總額預算支付制度下牙醫醫療品質……………… 22
第三章. 研究方法
3.1 研究流程…………………………………………………… 25
3.2 信度與效度………………………………………………… 26
3.3 研究假說…………………………………………………… 27
3.4 受訪對象與問卷設計原則………………………………… 28
3.5 問卷發放模式……………………………………………… 30
3.6 定義有效問卷……………………………………………… 32
第四章 問卷分析與結果
4.1 問卷回收率………………………………………………… 33
4.2 受訪者的基本資料………………………………………… 34
4.3 牙科住院醫師訓練內容與師資等資源…………………… 39
4.4 牙科住院醫師訓練的成效………………………………… 42
4.5 牙科住院醫師未來專業生涯規劃………………………… 44
第五章 討論
5.1 類似研究的回收率比較…………………………………… 45
5.2 牙科住院醫師接受訓練的動機…………………………… 47
5.3 健保環境下的住院醫師訓練及成效……………………… 55
5.4 住院醫師預定辭職率……………………………………… 59
5.5 健保環境與牙醫師專科訓練……………………………… 63
第六章 結論與建議
6.1 結論………………………………………………………… 65
6.2 研究限制…………………………………………………… 66
6.3 建議………………………………………………………… 67
附錄與表………………………………………………………………


圖一 問卷發放與回收流程………………………………………
圖二 醫院牙科與基層牙醫診所的角色區分……………………
圖三 住院醫師訓練前在診所執業年數……………………………
圖四 在受訓期間是否感受到經濟需求……………………………
圖五 接受住院醫師訓練的原因……………………………………
圖六 期待接受住院醫師訓練後的收穫……………………………
圖七 對於成為特定專科的住院醫師的想法………………………
圖八 想/不想成為特定專科住院醫師的理由……………………
圖九 對於參加專科醫師訓練的看法………………………………
圖十 牙科住院醫師預定一年內離職之原因………………………
表一 研究樣本的基本資料…………………………………………
表二 接受住院醫師訓練的原因與期待……………………………
表三 對於成為特定專科的住院醫師的想法………………………
表四 全民健保對住院醫師訓練內容的影響………………………
表五 住院醫師離職意願與離職原因………………………………
表六 對於訓練後的自我評估………………………………………
表七 對於參加專科醫師訓練的看法………………………………
表八 不同類別醫院與年資之分布(百分比) ………………………
表九 參加住院醫師訓練的原因與期望,依醫院類別與年資分(百分比)
表十 成為固定專科的住院醫師,依醫院類別與年資分(百分比)
表十一 健保環境與醫療行為,依醫院類別與年資分(百分比)……
表十二 離職意願,依醫院類別與年資分(百分比) ………………
表十三 參與專科醫師訓練的意願,依醫院類別與年資分(百分比)
表十四 住院醫師再進修科目…………………………………………
表十五 牙醫系畢業生人數與受訪住院醫師比例……………………
表十六 健保申報項目於全臺灣六分區之平均每人申報量…………
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