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研究生:侯世環
研究生(外文):Hou,Shih-Huan
論文名稱:臨床訓練及導師制度在醫學專業養成上的角色
論文名稱(外文):The Roles of Clinical Training and Mentoring in the Development of Medical Expertise
指導教授:陳姵樺陳姵樺引用關係
指導教授(外文):Chen, Pei-Hua
口試委員:李建賢王精文方聖平唐麗英洪瑞雲
口試日期:2016-07-07
學位類別:博士
校院名稱:國立交通大學
系所名稱:管理科學系所
學門:商業及管理學門
學類:企業管理學類
論文種類:學術論文
論文出版年:2016
畢業學年度:104
語文別:中文
論文頁數:122
中文關鍵詞:專業發展模式醫學專業住院醫師訓練專業素養
外文關鍵詞:model of professional developmentmedical practitionersresidency trainingprofessionalism
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本研究以半結構方式訪談56位醫師,目的在探討醫師如何透過臨床訓練過程,以建立專業能力及專業素養。受訪醫師依年資深淺分為三組,比較此三組醫師對住院醫師訓練的內容及方法,以及完成住院醫師之後,仍須學習的地方的意見,藉以建構醫學發展的階段模式。研究結果發現,醫學專業發展一開始為生手階段,是擔任住院醫師 (約年資1-3年)的前數年,其主要的工作為熟悉與適應醫療專業體制。其次為建立專業能力的階段,相當於住院醫師訓練的後期 (年資4-7年),其主要工作為在主治醫師的監督下,建立獨立執業的醫療專業能力。第三是持續精進專業能力的階段,此階段的任務為發展出以服務他人為導向的專業執業態度,大約是在成為主治醫師的前幾年 (年資6-12年)。最後的階段為專業精神的實踐,約為專業年資12年以上的主治醫師方能達到。此階段的醫師除了專業醫療能力之外,並具有專業素養,關注整個醫療系統的發展與醫學知識的進展。受訪醫師資料顯示,有資深醫師的指導是增進臨床醫學能力的主要方式,其中年資最高的主治醫師組曾在執業生涯中,遇見足以為榜樣的導師的比例最高 (65.0%)。本研究所建立之醫學專業發展模式可能推廣到其他專業領域。
Fifty-six medical doctors were interviewed to explore factors contribute to professional development in medical practice. They were classified into three groups according to their tenure. Similarities and differences among these three groups of physicians were analyzed according to a four-stage model of professional development. The data show that in the first several years, the fledging doctors are still novices. The major task at this stage (stage 1) is to learn the basic medical skills and routine operations of a hospital. About four or more years of clinical practices are required to assist them gain professional competences (stage 2). In medicine, residency training is a kind of supervised learning to help fledging doctors gain professional competences with assistance from attending physicians. Attending physicians with six to twelve years of practice may begin to show concern for the patients and patients’ family which characterizes the stage 3 professional development, namely, shifting one’s focus from self-centered practice to client-centered practice, and become an independent and responsible professional. Attending physicians with more than twelve years of experience might have reached the stage 4 development which is characterized by a high degree of professionalism and a continuous concern for profession’s future development. Almost all attending physicians considered one-by-one assistance from senior attending physicians the most effective way to help fledging doctors gain professional competences. Data also show that most attending physicians (65.0%) reported having met a mentor during their career development. A model of medical professional development was proposed and its educational implications discussed.
中文摘要…………………………..……………………………………………i
英文摘要………………………………………….……………………………ii
致謝…………………………………………………………………………iii
目錄…………………………………………………………………………iv
表目錄………………………………..………………...............……v
一、緒論…………………………………...………………………..………….1
二、文獻探討………………………………………………………………..…6
三、研究方法…………………………..……………………………………..37
四、結果………………………………..……………………………………..42
五、結論與討論………………………..……………………………………109
參考文獻……………………………..………………………………………113
附錄一…………………………………..……………………………………119
附錄二…………………………………..……………………………………121
參考文獻
林佳慧 (2006)。影響醫師專業化程度與組織-專業人員間衝突之相關因素探討 (碩士論文),國立交通大學管理科學系。
國立臺灣大學醫學院醫學系。簡介。民106年7月1日,取自:http://www.med.ntu.edu.tw/main.php?Page=A4
臺大醫院內科部。住院醫師訓練。民106年7月1日,取自:http://ntuh.mc.ntu.edu.tw/med/education/edu_resident.asp
臺大醫院內科部。醫學系學生教學。民106年7月1日,取自:http://www.ntuh.gov.tw/med/default.aspx
ABIM Foundation, CP–ASIM Foundation, & European Federation of Internal Medicine. (2002) Medical Professionalism in the new millennium: A physician charter. Annals of Internal Medicine, 136(3), 243-246.
Akkerman, S. F., & Bakker, A. (2012) Crossing boundaries between school and work during apprenticeship. Vocations and Learning, 5, 153-173.
Albanese, M., & Mitchell, S. (1993). Problem-based learning: A review of literature on its outcomes and implementation issues. Academic Medicine, 68, 52-81.
Anderson, D. S., Stacey, B. G., Western, J. S., & Williams, T. H. (1983) Career development in four professions: An empirical study. Psychological Reports, 53, 1263-1270.
Anderson, E. M., & Shannon, A. L. (1995). Toward a conceptualization of mentoring. In T. Kerry & A. S. Mayes (Eds.), Issues in mentoring (pp. 25–34). New York: Routledge.
Arnold, L., & Stern, D. T. (2006) What is medical professionalism? In: Stern, D.T. (ed.). Measuring medical professionalism. New York: Oxford University Press.
Baker, M., Wrubel, J. & Rabow, M. W. (2011) Professional development and the informal curriculum in end-of –life care. Journal of Cancer Education, 26, 444-450.
Barrett, E., Barton, L., Furlong, J., Galvin, C. Miles, S., & Whitty, G. (1992). New routes to qualified teacher status. Cambridge Journal of Education, 22, 323-326.
Barzansky, B. (1992). The growth and divergence of the basic science. In B. Barzansky, & N, Gevitz (Eds.), Beyond Flexner: Medical Education in the Twentieth Century. New York: Greenwood.
Becker, H. S., Geer, B., Hughes, E. C., & Strauss, A. L. (1961). Boys in White: Student Culture in Medical School. Chicago: University of Chicago Press.
Benner, P. (1984) From novice to expert: Excellence and power in clinical nursing practice. Menlo Park: Addison-Wesley.
Boshuizen, H. P. A., Schmidt, G. H., Custers, E. J. F. M., & Wiel, M. W. J. van de (1995). Knowledge development and restructure in the domain of medicine: The role of theory and practice. Learning and Instruction, 5, 269-289.
Cimino, J. J. (1999). Development of expertise in medical expertise. In R. J. Sternberg, & J. A. Horvath, (Eds.), Tacit Knowledge in Professional Practice (pp. 101-120).
Mahwah, NJ: Lawrence Erlbaum Associates.
Connor , M. P., Bynoe, A. G., Redfern, N., Pokora, F., & Clarke, F. (2000). Developing senior doctors as mentors: A form of continuing professional development. Report of an initiative to develop a network of senior doctors as mentors: 1994-99. Medical Education, 34, 747–753.
Coy, M. W. (Ed.) (1989). Apprenticeship: From Theory to Method and Back Again.
Albany, N.Y.: State University of New York Press.
Dewey, J. (1910). How We Think. London: D. C. Heath.
Dewey, J. (1933). How We Think: A restatement of the Relation of Reflective Thinking in the Education Process. Chicago: Henry Regnery.
Dreyfus, H. L., & Dreyfus, S. E. (2005) Expertise in real world contexts. Organization Studies, 26(5), 779-792
Ericsson, Y. A., & Smith, J. (Eds.). (1991). Toward a general theory of expertise. New York: Cambridge University Press.
Feltovich, P. J., Coulson, R. L., Spiro, R. J. & Dawson-Saunders, B. K. (1991). Knowledge application and transfer for complex tasks in ill-structured domains: Implications for instruction and testing in biomedicine. In D. A. Evans, & V. L. Patel (Eds.), Advanced Models of Cognition for Medical Training and Practice (pp. 213-244). Berlin, Germany: Springer.
Flexner, A. (1910). Medical Education in the United States and Canada. (Bulletin No. 4). New York: Carnegie Foundation for the Advancement of teaching.
Furlong, V. J., Hirst, P. H., Pocklington, K., & Miles, S. (1988). Initial Teacher Training and the Role of the School. Milton Keynes: Open University Press.
Furlong, J., & Maynard, T. (1995). Mentoring student teachers. New York: Routledge.
Ho, M.-J., Yu, K.-H., Hirsh, D., Huang, T.-S., & Yang, P.-C. (2011). Does one size fit all? Building a framework for medical professionalism. Academic Medicine, 86, 1407–1414.
Hoffman, R. R., Shadbolt, N. R., Burton, A. M., & Klein, G. (1995). Eliciting knowledge from experts: A methodological analysis. Organizational Behavior and Human Decision Processes, 62, 129-158.
Jewson, N. D. (1976). The disappearance of the sick-man from medical cosmology, 1770-1870. Sociology, 10, 225-244.
Klemp, C. O. (1980). Three Factors of Success in the World of Work. Boston: McBor & Co.
Lave, J., & Wenger, E. (1991). Situated learning: Legitimate peripheral participation. New York: Cambridge University Press.
Levinson, W., Ginsburg, S., Hafferty, F. W., & Lucey, C. R. (2014) Understanding Medical Professionalism. China: McGraw-Hill Education.
Marshall, K. (1991). NVQs: An assessment of the outcomes approach to education and training. Journal of Further and Higher Education, 15, 50-64.
Merton, R. K., Reader, G. G., & Kendall, P.L. (Eds.) (1957). The Student-Physician. Cambridge, Mass.: Harvard University Press.
Miles, S., Barrett, E., Barton, L., Furlong, J., Galvin, C., & Whitty, G. (1993). Initial teacher education in England and Wales: A Topography. Research Papers in Education, 8(3), 275-304.
Orr, K. & Gao, Y. (2013) Becoming an architect: The role of work-based learning in architect training. Vocations and Learning, 6, 221-235.
Ostroff, C., & Kozlowski, S.W. (1993). The role of mentoring in the information gathering processes of newcomers during early organizational socialization.
Journal of Vocational Behavior, 42, 170-183.
Patel, V. L., Arocha, J. F., & Kaufman, D. R. (1999). Expertise and tacit knowledge in medicine. In R. J. Sternberg, & J. A. Horvath, (Eds.), Tacit Knowledge in Professional Practice (pp. 75-99). Mahwah, NJ: Lawrence Erlbaum Associates.
Patel, V. L., Groen, G. J., & Arocha, J. F. (1990). Medical expertise as a function of
task difficulty. Memory & Cognition, 18, 394-406.
Patel, V. L., Kaufman, D. R., & Magder, S. A. (1996). The acquisition of medical expertise in complex dynamic environments. In K. A. Ericsson (Ed.), The road to excellence: The acquisition of expert performance in the arts and sciences, sports and games. Mahwah, NJ: Lawrence Erlbaum Association.
Polanyi, M. (1983). The tacit dimension. Gloucester, Mass.: Peter Smith.
Ramanan, R. A., Taylor, W. C., Davis, R. B., & Phillips, R. S. (2006). Mentoring matters: Mentoring and career preparation in internal medicine residency training. Journal of General Internal Medicine, 21, 1-6.
Reed, R. R., & Evans, D. (1987). The deprofessionalization of medicine: Causes, effects and responds. Journal of the American Medical Association, 258, 3279-3282.
Rikers, R. M. J. P., Schmidt, H. G., & Boshuizen, H. P. A. (2002). On the constraints of encapsulated knowledge: Clinical case representation by medicine experts and subexperts. Cognition and Instruction, 20, 27-45.
Rogoff, B. (1991). Social interaction as apprenticeship in thinking: guidance and participation in spatial planning. In L. B. Resnick, J. M. Levine, & S. D. Teasley (Eds.), Perspectives on socially shared cognition. Washington, DC: American Psychological Association.
Rose, G. L., Rukstails, M. R., & Schuckit, M. A. (2005). Informal mentoring between faculty and medical students. Academic Medicine, 80, 344-348.
Schmidt, H. G., & Rikers, R. M. (2007) How expertise develops in medicine: Knowledge encapsulation and illness script. Medical Education, 41 (12), 1133-1139.
Schön, D.A. (1983). The Reflective Practitioner. Basic Books, Inc.
Schön, D. A. (1987). Educating the Reflective Practitioner. San Francisco: Jossey Bass.
Sinclair, S. (1997). Making Doctors: An Institutional Apprenticeship. Oxford, UK: Berg.
Singleton. J. (1989). Japanese folkcraft pottery apprenticeship. In M.W. Coy (Ed.), Apprenticeship: From Theory to Method and Back Again (pp.18-21). Albany, N.Y.: State University of New York Press.
Snell, L. M., Battles, J B., Bedford, J. A., & Washington, E. T. (1998). Verifying the curriculum of a family medicine clerkship. Medical Education, 32(4), 370-375.
Spandorfer, J., Pohl, C. A., Rattner, S. L., & Nasca, T. J. (2010) Professionalism in Medicine. New York: Cambridge University Press.
Stegeman, J. H., Schoten, E. J., & Terpstra, O. T. (2013) Knowing and acting in the clinical workplace: trainees’ perspectives on modeling and feedback. Advances in Health Sciences Education, 18(4), 597-615.
Stern, D. T. (2006). Measuring medical professionalism. New York City, NY: Oxford University Press.
Street, C. (2004). Examining learning to teach through a social lens: How mentors guied newcomers into a professional community of learners. Teacher Education Quarterly, 31, 7-24.
Sun, R., Slusarz, P., & Terry, C. (2005). The interaction of the explicit and the implicit in skill learning: A dual-process approach. Psychological Review, 112, 159-192.
Tallis, R. C. (2006) Doctors in Society: Medical Professionalism in a changing world. Clinical Medicine, 6(1), 7-12.
The Royal Australasian College of Physicians (2010). Supporting physicians’ professionalism and performance – A literature review. Retrieved October 10, 2012, from the World Wide Web: http://www.racp.edu.au/page/sppp/.
Tulving, E. (1974). Cue-dependent forgetting. American Scientist, 62, 74-82.
Van de Wiel, M. W. J., & Van den Bossche, P. (2013) Deliberate practice in medicine: The motivation to engage in work-related learning and its contribution to expertise. Vocations and Learning, 6, 135-158.
Vernon, D. T., & Blake, R. L. (1993). Does problem-based learning work? A meta-analysis of evaluative research. Academic Medicine, 68, 550-563
Vygotsky, L. S. (1978). Mind in Society: The Development of Higher Psychological Process. Cambridge, MA: Harvard University Press.
Wagner, P., Hendrich, J., Hoseley, G., & Hudson, V. (2007). Defining medical professionalism: A qualitative study. Medical Education, 41, 288–294.
Whitty, G., Barrett, E., Barton, L., Furlong, J., Galvin, C., & Miles, S. (1992). Initial teacher training in England and Wales: A survey of current practices and concerns. Cambridge Journal of Education, 22, 293-306.
Wimmers, P. F., Schmidt, H. G., & Splinter, T. A W (2006). Influence of clerkship experiences on clinical competence. Medical Education, 40, 450-458.
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