| 摘要: | 論文名稱：影響二年期牙醫師畢業後一般醫學訓練計劃制度之因素研究
臺北醫學大學口腔醫學院牙醫學系研究所
研究生姓名： 王泳泉
畢業年度：一○八年學年度第二學期
指導教授：鄭信忠 臺北醫學大學口腔醫學院牙醫學系研究所教授
「二年期牙醫師畢業後一般醫學訓練計劃」於民國 99 年 7 月開始實施。其主要目的為建立系統性的牙醫師畢業後綜合臨床醫學訓練制度，銜接學校教育與臨床服務，加強一般牙科全人治療之能力。參與計畫的牙醫師會於醫院或診所進行訓練，學員是否因學習環境不同而有學習成效的差異問題存從未分析或探討。另外進一部探討其他影響可能的影響因子。
本研究以 106 年全台灣 PGY 訓練機構為母群體。依台灣北中南東四地區，分層依比例隨機抽樣。共抽樣醫院 20 間、診所 50 間。由於訓練機構配合度問題，採用立意抽樣，選取對參與研究有興趣之較大型診所。最後於 107 年 05 月至 107 年 07 月實地訪視醫院 24 間、診所 14 間。共有 166 位 PGY醫師參與 OSCE、196位參與醫學知識、專業素養評估問卷評量與 222 位參與牙科 PGY 制度問卷調查。以及共 33 位機構負責人參與牙科PGY制度問卷。
結果顯示在 OSCE 評量結果進行優勢比分析，在照護能力 (診所：醫院 OR: 2.16, 95% CI: 1.09-4.28)、人際溝通 (診所：醫院 OR: 6.78, 95% CI: 2.54-18.1) 與整體情形 (診所：醫院 OR: 3.12, 95% CI: 1.68-5.79) 方面，醫院 PGY 醫師的表現優於診所 PGY 醫師的表現。其他的影響整體情形的因素為年齡 (小於等於27歲：大於27歲OR: 0.77, 95% CI: 0.62-0.97)、性別 (男性：女性 OR: 1.27, 95% CI: 1.02-1.57)、國內外大學學歷 (國外：國內OR: 1.80, 95% CI: 1.15-2.81)、畢業年度 (畢業年度大於等於2015：畢業年度小於2015 OR: 1.80, 95% CI: 1.15-2.81) 以及 PGY 前是否執業 (曾執業：無執業 OR: 1.81, 95% CI: 1.42-2.30)。在醫學知識、專業素養評估問卷醫院與診所沒有顯著差異(P = 0.4)。針對 PGY 學員以及負責人問卷調查發現，醫院與診所在提供 PGY 的期刊研討次數、病例報告次數、專題演討次數與親自報告次數上，醫院優於診所。在指導師資、課程規劃、訓練機構與訓練要件上進行優勢比分析，除少部分項目外，診所PGY 醫師滿意度高過醫院。對於牙醫PGY的制度及各調查項目，醫院及診所之牙醫PGY 學員與負責人均比較偏好自己所在的訓練機構類型。
建議牙醫PGY評鑑應對醫院牙科及牙醫診所有一致的評鑑要求，並逐漸從嚴，設立退場機制，漸進提升牙醫PGY教學品質，保障PGY學員的學習權益。
Title of Thesis：The study of affecting factors on “Two Years
General Medicine Training Program of Dentist
Post-Graduate Year” in Taiwan
Author： Wang, Yung-Chuan
Thesis advised by ： Cheng, Hsin-Chung
Taipei Medical University,
Graduate Institute of Dentistry
“Two years General Medicine Training Program of dentist Post-Graduate Year” was officially implemented in Taiwan 2010. Its main purpose is to establish a systematic post-graduate clinical training system, to connect undergraduate education and clinical services, and to increase the ability of patient-centered care in general dental practice. The dentists participating in the program will be trained in hospitals or clinics. Its main purpose is to improve the clinical ability of dentists and promote the development of dental education and medical quality. The dentists participating in the program will be trained in hospitals or clinics. The training outcoming between different training institutes has never been analyzed or discussed. We also explored the other possible affecting factors.
This study used PGY training institutions in Taiwan during the year 2017 as the population. Proportionate stratified random sampling is used, according to the North, Central, South, and East regions of Taiwan. The samples include 20 hospitals and 50 clinics. Due to insufficient participation of institutions, used purposive sampling. Finally, we visited 24 hospitals and 14 clinics from May to July 2018. A total of 166 PGY trainees participated in OSCE, 196 PGY trainees participated in medical knowledge exam, 222 PGY trainees participated in the PGY satisfied and the system questionnaire and a total of 33 chairmen of training institutions participated in the PGY and the system questionnaire.
The results show that in terms of OSCE by odds ratio, capability to care (Clinics PGY: hospital PGY OR: 2.16, 95% CI: 1.09-4.28), patient communications (Clinics PGY: hospital PGY OR: 6.78, 95% CI: 2.54-18.1), overall score (Clinics PGY: hospital PGY OR: 3.12, 95% CI: 1.68-5.79) the performance of PGY trainees in the hospitals is superior to PGY trainees in dental clinics. Other significant affecting factors are age (≤ 27 y/o: > 27 y/o OR: 0.77, 95% CI: 0.62-0.97), gender (Male: Female OR: 1.27, 95% CI: 1.02-1.57), domestic or international graduate (International: domestic OR: 1.80, 95% CI: 1.15-2.81), graduation year ( ≥ 2015: <2015 OR: 1.80, 95% CI: 1.15-2.81), and practicing before PGY training or not (Practicing: Not Practicing OR: 1.81, 95% CI: 1.42-2.30). There was no significant difference in the medical knowledge exam between trainees in the hospitals or the dental clinics (P = 0.4). In the PGY satisfied and the system questionnaire filled out by the trainees, the trainees in the dental clinics are more satisfied than the trainees in the hospitals, but the hospitals hold more case reports and meetings than the dental clinics. In the PGY system questionnaire filled out by the chairman of institutions, the chairmen of the hospitals felt the training environment in the hospital is better than in the dental clinic, and vice versa.
According to the results, accreditation of the training institutions should be consistent between the hospitals and the dental clinics, gradually tighten, and set up an exit mechanism to protect the learning rights of PGY students. |
