運用整合式臨床技術教學模加強新制醫學生臨床技能學習之成效

Background: A unique curriculum reform was implemented in Taiwan which took effect from the 2013 medical student cohort: the duration of study reduces from 7 to 6 years. The first generation of the new curriculum had already graduated in July, 2019 and became a new medical force in Taiwanese medical system. From a cohort study conducted by the applicant which followed the first generation of medical students from the new curriculum for two years, their medical knowledge was comparable with the students from the old curriculum. However, their preparedness of clinical skills was much worse than the students from the old curriculum. Learning of medical knowledge can be done through self-directed learning, but clinical skills are practiced either on the manikins or real patients. Due to the fact that their clinical practice is one year less than the old curriculum students, the clinical skills education must be more efficient and effective to cope with the curriculum change. Methods: We implemented a novice medical skill training model in the Clinical Skills Center of Chang-Gung Memorial Hospital, Linkou branch, using flipped classroom, direct observation with real-time feedback, and small group hands-on practice methods. Volunteer medical students were recruited through poster. The Eleven procedural skills included endotracheal tube insertion, urinary catheter insertion, wound suture, wound dressing change, nasogastric tube placement, electrocardiography, basic life support, intravenous catheter placement, arterial blood sampling, throat swab, and pap smear. Their learning outcomes and relevant information were gathered for analysis. Results: A total of 111 medical students participated this course during the one-year period. The students reported a high approval rates towards the course. They showed a variety of different familiarities for the 11 clinically important intervention skills Overall, their self-efficacy were highest for the electrocardiography (score=8.8), urinary catheter insertion (score=7.59), and wound care (score=6.42), and lowest for endotracheal tube insertion (score=3.57), wound suture (score=4.51), and intravenous catheter placement (score=3.45). The senior medical students possessed a higher self-efficacy. The improvement of the self-efficacy was affected by the pre-class efficacy. Discussion and conclusion: This novice course presented with a high approval rate and a good improvement in the medical student’s clinical procedural skills. The data also reflects how much chances the students have for practice in real clinical situations, which provides the educator valuable information in designing procedural simulations. The medical students in Taiwan were generally familiar with procedures such as electrocardiography, urinary catheter insertion, and wound care, and less familiar with endotracheal tube insertion, wound suture, and intravenous catheter placement.

Project ID:RP00000025
External Project ID:PSK1090249

15-Mar-2022