期刊專區/ Periodical Section

醫學教育未來發展之重要趨勢探討：課程與教學

Trends in the Development of Medical Education: Curriculum and Instruction

所屬期刊：	第6卷第2期 「課程與教學」 主編：國立中正大學課程研究所教授 蔡清田
系統編號：	vol021_04
主題：	課程與教學
出版年份：	2010
作者：	陸希平;吳毓瑩;陳美足;陳美惠
作者(英文)：	Shi-Ping Luh; Yuh-Yin Wu; Mei-Tsu Chen; Mei-Hui Chen
論文名稱：	醫學教育未來發展之重要趨勢探討：課程與教學
論文名稱(英文)：	Trends in the Development of Medical Education: Curriculum and Instruction
共同作者：
最高學歷：
校院名稱：
系所名稱：
語文別：
論文頁數：	26
中文關鍵字：	模擬學習;臨床能力;醫學倫理;醫學教育;繼續教育
英文關鍵字：	continuing education; medical education; medical ethics; medical professional competence; simulator in learning
服務單位：	嘉義聖馬爾定醫院副院長及外科教授;國立嘉義大學及國立交通大學教授;國立台北教育大學心理與諮商學系教授;嘉義聖馬爾定醫院醫療副院長;嘉義聖馬爾定醫院院長
稿件字數：	10163
作者專長：	醫學教育
投稿日期：	2009/8/6
論文下載：
摘要(中文)：	醫學教育在課程與教學上的改革經過近幾十年來的發展，已在世界各地建立了嶄新的教育模式。放眼未來，醫學教育將會擷取其他專業教育的特質，將之融入其中, 繼續進行創新並影響其他領域教育的發展。本文利用文獻回顧，對於未來趨勢作一綜覽性的探討，包括：1.有效的學習與傳授醫學知識, 技術與態度。2.模擬器學習的應用, 效果與其限制。3.定義臨床能力, 及其對未來生涯發展大影響。4.專業教育由畢業前延伸至畢業後, 強調持續與終身學習的精神。 5.使用有效多元的能力評估工具。6.強調醫學倫理的教育。最後我們提出醫學教育目標從醫師中心轉而以求診者為中心的典範轉移以及醫學教育未來需面對的挑戰作為結論。
摘要(英文)：	A brand new model in medical education regarding curriculum and instruction has been created worldwide through continuous reform during these decades. Several excellent literature reviews and studies have given us important messages about the trends in the future development of medical education. In this article we focused on the following key issues. 1) locate the elements of effective learning; 2) adopt simulatorsits application, effects and limitations; 3) define the medical professional competenceits importance in the future career development; 4) extend continuing and life long educationfrom pre-graduate to post-graduate; 5) utilize effective competences assessment tools; and 6) teach and assess medical ethics present status and future perspectives. Finally, paradigm shift of medical education curriculum from doctor-center to patient-center, as well as future challenges were discussed as concluding remarks.
參考文獻：	Accreditation Council on General Medical Education (ACGME). (2003, 2003/5/28). from http://www.acgme.org/outcome/project/outintro.htm ACPGBI: Training in coloproctology. (2006/12/20). from http://www.acpgbi.org.uk/training/training.html. Anastakis, D. J., Regehr, G., Reznick, R. K., Cusimano, M., Murnaghan, J., Brown, M., et al. (1999). Assessment of technical skills transfer from the bench training model to the human model. Am J Surg, 177(2), 167-170. Aviation Simulation Technology, Inc. (2009/04/08). from http://www.ast-simulators.com/site/index.html Bansal, P. K. (2007). "Generalist" Medical Graduate to a "Specialty" Resident: Can an Entry Level Assessment Facilitate the Transition? Assessing the Preparedness Level of New Surgical Trainee. Paper presented at the the 4th APMEC in Singapore. Benbassat, J., Baumal, R., Borkan, J. M., & Ber, R. (2003). Overcoming barriers to teaching the behavioral and social sciences to medical students. Acad Med, 78(4), 372-380. Biasutto, S. N., Caussa, L. I., & Criado del Rio, L. E. (2006). Teaching anatomy: cadavers vs. computers? Ann Anat, 188(2), 187-190. Buttery, C. M. (2006). Does continuing medical education work? BMJ, 333(7558), 99. Campbell, A. V. (1989). On a principled medical ethic. Fam Pract, 6(2), 81-82. Carter, F. J., Schijven, M. P., Aggarwal, R., Grantcharov, T., Francis, N. K., Hanna, G. B., et al. (2005). Consensus guidelines for validation of virtual reality surgical simulators. Surg Endosc, 19(12), 1523-1532. Case, S., & Swanson, D. (2000). Constructing written test questions for the basic and clinical sciences (3rd ed.). Philadelphia: National Board of Medical Examiners. Charlin, B., Roy, L., Brailovsky, C., Goulet, F., & van der Vleuten, C. (2000). The Script Concordance test: a tool to assess the reflective clinician. Teach Learn Med, 12(4), 189-195. Clements, R., & Mackenzie, R. (2005). Competence in prehospital care: evolving concepts. Emerg Med J, 22(7), 516-519. Cobanoglu, N., & Kayhan, Z. (2006). An assessment of medical ethics education. Nurs Ethics, 13(5), 558-561. Colliver, J. A., Vu, N. V., & Barrows, H. S. (1992). Screening test length for sequential testing with a standardized-patient examination: a receiver operating characteristic (ROC) analysis. Acad Med, 67(9), 592-595. Corrigan, G., Bowden, F. J., & Owen, C. (2006). Mini-clinEx versus mini-CEX. Med Educ, 40(6), 599-600.Curry, R. H., & Makoul, G. (1998). The evolution of courses in professional skills and perspectives for medical students. Acad Med, 73(1), 10-13. Daher, M. (2006). Current trends in medical ethics education. J Med Liban, 54(3), 121-123. Davis, D., OBrien, M. A., Freemantle, N., Wolf, F. M., Mazmanian, P., & Taylor-Vaisey, A. (1999). Impact of formal continuing medical education: do conferences, workshops, rounds, and other traditional continuing education activities change physician behavior or health care outcomes? JAMA, 282(9), 867-874. Davis, D. A., Thomson, M. A., Oxman, A. D., & Haynes, R. B. (1995). Changing physician performance. A systematic review of the effect of continuing medical education strategies. JAMA, 274(9), 700-705. Dawson, D. L., Meyer, J., Lee, E. S., & Pevec, W. C. (2007). Training with simulation improves residents endovascular procedure skills. J Vasc Surg, 45(1), 149-154. Deiber, M. P., Missonnier, P., Bertrand, O., Gold, G., Fazio-Costa, L., Ibanez, V., et al. (2007). Distinction between perceptual and attentional processing in working memory tasks: a study of phase-locked and induced oscillatory brain dynamics. J Cogn Neurosci, 19(1), 158-172. del Pozo, P. R., & Fins, J. J. (2005). The globalization of education in medical ethics and humanities: evolving pedagogy at Weill Cornell Medical College in Qatar. Acad Med, 80(2), 135-140. Delzell, J. E., Jr., Ringdahl, E. N., & Kruse, R. L. (2005). The ACGME core competencies: a national survey of family medicine program directors. Fam Med, 37(8), 576-580. du Boulay, C. (2000). From CME to CPD: getting better at getting better? BMJ, 320(7232), 393-394. Dunkin, B., Adrales, G. L., Apelgren, K., & Mellinger, J. D. (2007). Surgical simulation: a current review. Surg Endosc, 21(3), 357-366. Dutta, S., Gaba, D., & Krummel, T. M. (2006). To simulate or not to simulate: what is the question? Ann Surg, 243(3), 301-303. Dutta, S., & Krummel, T. M. (2006). Simulation: a new frontier in surgical education. Adv Surg, 40, 249-263. Epstein, R. M. (2007). Assessment in medical education. N Engl J Med, 356(4), 387-396. Epstein, R. M., & Hundert, E. M. (2002). Defining and assessing professional competence. JAMA, 287(2), 226-235. Erickson, S. A. J. (1985). Fusing AI and simulation in military modeling. Paper presented at the Artifical intelligence in simulation conference. Eva, K. W., & Regehr, G. (2005). Self-assessment in the health professions: a reformulation and research agenda. Acad Med, 80(10 Suppl), S46-54.Eva, K. W., Solomon, P., Neville, A. J., Ladouceur, M., Kaufman, K., Walsh, A., et al. (2007). Using a sampling strategy to address psychometric challenges in tutorial-based assessments. Adv Health Sci Educ Theory Pract, 12(1), 19-33. Fenderson, B. A. (2005). Strategies for teaching pathology to graduate students and allied health professionals. Hum Pathol, 36(2), 146-153. Friedman Ben-David, M. (2000). The role of assessment in expanding professional horizons. Medical Teacher, 22(5), 472-477. Global minimum essential requirements in medical education. (2002). Med Teach, 24(2), 130-135. Goldie, J., Schwartz, L., McConnachie, A., & Morrison, J. (2001). Impact of a new course on students potential behaviour on encountering ethical dilemmas. Med Educ, 35(3), 295-302. Gross, M. L. (2001). Medical ethics education: to what ends? J Eval Clin Pract, 7(4), 387-397. Hakastian, R. A. (1971). The effects of type of examination anticipated on test preparation and performance. The Journal of Educational Research, 64, 319-324. Harden, R. M. (2006a). International medical education and future directions: a global perspective. Acad Med, 81(12 Suppl), S22-29. Harden, R. M. (2006b). Trends and the future of postgraduate medical education. Emerg Med J, 23(10), 798-802. Herbert, C. L. (1997). To be or not to bean ethical debate on the not-for-resuscitation (NFR) status of a stroke patient. J Clin Nurs, 6(2), 99-105. Hundert, E. M., Hafferty, F., & Christakis, D. (1996). Characteristics of the informal curriculum and trainees ethical choices. Acad Med, 71(6), 624-642. Hunt, E. (1968). Computer simulation: artificial intelligence studies and their relevance to psychology. Annu Rev Psychol, 19, 135-168. Iramaneerat, C. (2006). Moral education in medical schools. J Med Assoc Thai, 89(11), 1987-1993. Issenberg, S. B., Gordon, M. S., & Greber, A. A. (2003). Bedside cardiology skills training for the osteopathic internist using simulation technology. J Am Osteopath Assoc, 103(12), 603-607. Issenberg, S. B., Petrusa, E. R., McGaghie, W. C., Felner, J. M., Waugh, R. A., Nash, I. S., et al. (1999). Effectiveness of a computer-based system to teach bedside cardiology. Acad Med, 74(10 Suppl), S93-95. JMLS - Multi-State Performance Test. (2006/07/18). from http://www.jmls.edu/events/Multi-State.asp Jones, J. W., McCullough, L. B., & Richman, B. W. (2005). Truth-telling about terminal diseases. Surgery, 137(3), 380-382.Khaliq, A. A., Dimassi, H., Huang, C. Y., Narine, L., & Smego, R. A., Jr. (2005). Disciplinary action against physicians: who is likely to get disciplined? Am J Med, 118(7), 773-777. Klass, D. (2000). Reevaluation of clinical competency. Am J Phys Med Rehabil, 79(5), 481-486. Kogan, J. R., Bellini, L. M., & Shea, J. A. (2002). Implementation of the mini-CEX to evaluate medical students clinical skills. Acad Med, 77(11), 1156-1157. Lawrence, J. W., Fauerbach, J. A., Heinberg, L. J., Doctor, M., & Thombs, B. D. (2006). The reliability and validity of the Perceived Stigmatization Questionnaire (PSQ) and the Social Comfort Questionnaire (SCQ) among an adult burn survivor sample. Psychol Assess, 18(1), 106-111. Le, C. Q., Lightner, D. J., VanderLei, L., Segura, J. W., & Gettman, M. T. (2007). The current role of medical simulation in american urological residency training programs: an assessment by program directors. J Urol, 177(1), 288-291. Leach, D. C. (2002). Competence is a habit. JAMA, 287(2), 243-244. Learning objectives for medical student educationguidelines for medical schools: report I of the Medical School Objectives Project. (1999). Acad Med, 74(1), 13-18. Leung, W. C. (2002). Competency based medical training: review. Bmj, 325(7366), 693-696. London, L., & McCarthy, G. (1998). Teaching medical students on the ethical dimensions of human rights: meeting the challenge in South Africa. J Med Ethics, 24(4), 257-262. MacDowall, J. (2006). The assessment and treatment of the acutely ill patientthe role of the patient simulator as a teaching tool in the undergraduate programme. Med Teach, 28(4), 326-329. Maharaj, C. H., Ni Chonghaile, M., Higgins, B. D., Harte, B. H., & Laffey, J. G. (2006). Tracheal intubation by inexperienced medical residents using the Airtraq and Macintosh laryngoscopesa manikin study. Am J Emerg Med, 24(7), 769-774. Makoul, G., Curry, R. H., & Novack, D. H. (1998). The future of medical school courses in professional skills and perspectives. Acad Med, 73(1), 48-51. Malek, J. I., Geller, G., & Sugarman, J. (2000). Talking about cases in bioethics: the effect of an intensive course on health care professionals. J Med Ethics, 26(2), 131-136. Mallott, D. (2006). Interview, Deans Letter, and Affective Domain Issues. Clin Orthop Relat Res, 449, 56-61. Mayer, P. S., Bailey, G. H., Mayer, R. J., Hillis, A., & Dvoracek, J. E. (1987). Locative inferences in medical texts. J Med Syst, 11(2-3), 123-135. Michael, J. (2006). Wheres the evidence that active learning works? Adv Physiol Educ, 30(4), 159-167. Military, police, law enforcement training,TSV. (2006, 2006/12/03). fromhttp://www.bioval.net/ Mukohara, K., Ban, N., Sobue, G., Shimada, Y., Otani, T., & Yamada, S. (2006). Follow the patient: process and outcome evaluation of medical students educational experiences accompanying outpatients. Med Educ, 40(2), 158-165. Nackman, G. B., Bermann, M., & Hammond, J. (2003). Effective use of human simulators in surgical education. J Surg Res, 115(2), 214-218. NCARB: National Council of Architectural Registration Boards. (2009/04/09). from http://www.ncarb.org/ Norcini, J. J. (2003). Peer assessment of competence. Med Educ, 37(6), 539-543. Norman, G. R. (1988). Problem-solving skills, solving problems and problem-based learning. Med Educ, 22(4), 279-286. Norman, G. R. (2000). The epistemology of clinical reasoning: perspectives from philosophy, psychology, and neuroscience. Acad Med, 75(10 Suppl), S127-135. Norman, G. R., & Schmidt, H. G. (1992). The psychological basis of problem-based learning: a review of the evidence. Acad Med, 67(9), 557-565. Norman, G. R., Van der Vleuten, C. P., & De Graaff, E. (1991). Pitfalls in the pursuit of objectivity: issues of validity, efficiency and acceptability. Med Educ, 25(2), 119-126. Papadakis, M. A., Hodgson, C. S., Teherani, A., & Kohatsu, N. D. (2004). Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board. Acad Med, 79(3), 244-249. Papadakis, M. A., Teherani, A., Banach, M. A., Knettler, T. R., Rattner, S. L., Stern, D. T., et al. (2005). Disciplinary action by medical boards and prior behavior in medical school. N Engl J Med, 353(25), 2673-2682. Parboosingh, I. J., & Gondocz, S. T. (1993). The Maintenance of Competence (MOCOMP) Program: motivating specialists to appraise the quality of their continuing medical education activities. Can J Surg, 36(1), 29-32. Pulito, A. R., Donnelly, M. B., Plymale, M., & Mentzer, R. M., Jr. (2006). What do faculty observe of medical students clinical performance? Teach Learn Med, 18(2), 99-104. Ramsey, P. G., Wenrich, M. D., Carline, J. D., Inui, T. S., Larson, E. B., & LoGerfo, J. P. (1993). Use of peer ratings to evaluate physician performance. JAMA, 269(13), 1655-1660. Rees, R., Kavanagh, J., Harden, A., Shepherd, J., Brunton, G., Oliver, S., et al. (2006). Young people and physical activity: a systematic review matching their views to effective interventions. Health Educ Res, 21(6), 806-825. Requardt, H. (2006). Technology solutions for better outcomes: integrated information management in key to productivity increases in medicine. Br J Radiol, 79(937), 17-23.Rethans, J. J., Norcini, J. J., Baron-Maldonado, M., Blackmore, D., Jolly, B. C., LaDuca, T., et al. (2002). The relationship between competence and performance: implications for assessing practice performance. Med Educ, 36(10), 901-909. Richardson, T. R., & Moody, J. M., Jr. (2000). Bedside cardiac examination: constancy in a sea of change. Curr Probl Cardiol, 25(11), 783-825. Roberts, K. E., Bell, R. L., & Duffy, A. J. (2006). Evolution of surgical skills training. World J Gastroenterol, 12(20), 3219-3224. Rolland, J. P., Wright, D. L., & Kancherla, A. R. (1997). Towards a novel augmented-reality tool to visualize dynamic 3-D anatomy. Stud Health Technol Inform, 39, 337-348. Ross, D. D., Keay, T., Timmel, D., Alexander, C., Dignon, C., OMara, A., et al. (1999). Required training in hospice and palliative care at the University of Maryland School of Medicine. J Cancer Educ, 14(3), 132-136. Royal College of Physicians & Surgeons of Canada. (2003, 2007/02/12). from http://www.rcpsc.medical.org Royal College of Physicians. (2003, 2006/11/23). from http://www.rcplondon.uk Saha, A., Poddar, E., & Mankad, M. (2005). Effectiveness of different methods of health education: a comparative assessment in a scientific conference. BMC Public Health, 5, 88. Stearns, J. A., Stearns, M. A., Paulman, P. M., Chessman, A. W., Davis, A. K., Sherwood, R. A., et al. (2007). Family Medicine Curriculum Resource Project: the future. Fam Med, 39(1), 53-56. Stefanidis, D., Sierra, R., Korndorffer, J. R., Jr., Dunne, J. B., Markley, S., Touchard, C. L., et al. (2006). Intensive continuing medical education course training on simulators results in proficiency for laparoscopic suturing. Am J Surg, 191(1), 23-27. Steinert, Y., Mann, K., Centeno, A., Dolmans, D., Spencer, J., Gelula, M., et al. (2006). A systematic review of faculty development initiatives designed to improve teaching effectiveness in medical education: BEME Guide No. 8. Med Teach, 28(6), 497-526. Tamblyn, R. M. (1998). Use of standardized patients in the assessment of medical practice. CMAJ, 158(2), 205-207. Teherani, A., Hodgson, C. S., Banach, M., & Papadakis, M. A. (2005). Domains of unprofessional behavior during medical school associated with future disciplinary action by a state medical board. Acad Med, 80(10 Suppl), S17-20. Thomas, M. D., OConnor, F. W., Albert, M. L., Boutain, D., & Brandt, P. A. (2001). Case-based teaching and learning experiences. Issues Ment Health Nurs, 22(5), 517-531. Thompson, J. W. (2006). Patient-centered care. J Am Acad Orthop Surg, 14(12), 636; author reply 637.Thompson, R. F., Thompson, J. K., Kim, J. J., Krupa, D. J., & Shinkman, P. G. (1998). The nature of reinforcement in cerebellar learning. Neurobiol Learn Mem, 70(1-2), 150-176. Tremblay, G. J., Drouin, D., Parker, J., Monette, C., Cote, D. F., & Reid, R. D. (2004). The Canadian Cardiovascular Society and knowledge translation: turning best evidence into best practice. Can J Cardiol, 20(12), 1195-1198. Triola, M., Feldman, H., Kalet, A. L., Zabar, S., Kachur, E. K., Gillespie, C., et al. (2006). A randomized trial of teaching clinical skills using virtual and live standardized patients. J Gen Intern Med, 21(5), 424-429. van. der. Vleuten,C. (1996). The assessment of professional competence: developments, research and practical implications. Advances in Health Sciences Education : Theory and Practice, 1, 41-67. Veloski, J., Boex, J. R., Grasberger, M. J., Evans, A., & Wolfson, D. B. (2006). Systematic review of the literature on assessment, feedback and physicians clinical performance: BEME Guide No. 7. Med Teach, 28(2), 117-128. Violato, C., Marini, A., Toews, J., Lockyer, J., & Fidler, H. (1997). Feasibility and psychometric properties of using peers, consulting physicians, co-workers, and patients to assess physicians. Acad Med, 72(10 Suppl 1), S82-84. Yang, L. X., & Lewandowsky, S. (2004). Knowledge partitioning in categorization: constraints on exemplar models. J Exp Psychol Learn Mem Cogn, 30(5), 1045-1064. Yedidia, M. J., Gillespie, C. C., Kachur, E., Schwartz, M. D., Ockene, J., Chepaitis, A. E., et al. (2003). Effect of communications training on medical student performance. JAMA, 290(9), 1157-1165. Zuberi, R. W., Bordage, G., & Norman, G. R. (2007). Validation of the SETOC instrument Student evaluation of teaching in outpatient clinics. Adv Health Sci Educ Theory Pract, 12(1), 55-69.