台灣跟美國醫學生進臨床自主學習有差嗎？

- 4月 27, 2022

很多醫師在養成的過程中，或多或少會聽到有老師評論美國醫學生是後醫制、有學貸壓力，因而臨床上較積極主動，而台灣醫學生是高中入學制，同學不確定自己對臨床是否有興趣、學習比較被動等。這些主觀的評論看似很有說服力，但真的是這樣嗎？

Photo by Brooke Cagle

為了回答這個問題，我們在台灣跟美國各挑選了一間學生都是高度自主學習者的醫學院 (台大vs.哈佛)，進行跨國比較的研究。這個問題的解答，我們發表在台灣的《醫學教育》雜誌，期望能讓台灣的醫學教師重新檢視自主學習的重要性，並在本土的脈絡下給予學員支持。

（附帶一提，上回在《醫學教育》發表已經是12年前從美國LCME引進學生自主評鑑制度，於學生時代跟何明蓉教授合寫的〈醫學院教育評鑑之學生自評－台大試辦經驗〉。歲月真的是無情。）

這邊幫大家總結：台灣跟美國醫學生在臨床上做自主學習並沒有差很多。扣除掉一些學習資源的差異，兩國醫學生在自主學習的個人特徵跟學習程序基本上是一致的。不過有一個很特別的地方是：台灣同學即便在自主學習的情境下，仍然很重視跟同儕一起學習，並且容易在進行團體學習活動時，會因不想出頭而避開原本可能的自主學習機會。

這些現象的背後可能還是跟儒家合群、注重關係的文化傳統有關，但仍有些我們教師可以著力的地方。教師若能給予資源來鼓勵同儕間學習、帶領團體教學活動時設計鼓勵發表意見跟提問的機制等，預期會對台灣醫學生的自主學習更有幫助。

以下為論文摘要：

Conceptualizing Medical Students' Self-directed Learning in the Clinical Setting - A Qualitative Study in Taiwan

Tzu-Hung Liu ； Kai-Kuen Leung ； Amy Marie Sullivan

醫學教育； 26卷1期 (2022 / 03 / 01) ， P46 - 58

Abstract

Clinical teachers have regarded self-directed learning (SDL) as an essential means of enabling students to take responsibility for their learning throughout clinical training. However, SDL in the clinical setting in Taiwan has not yet been described in the literature. Purpose: This study aims to illustrate Taiwanese student experiences of SDL in their clinical training and identify how local socio-cultural contexts differ from our previous study in the U.S. Methods: To conceptualize students' SDL experiences in the clinical setting, we conducted a qualitative study with 15 Taiwanese medical students at National Taiwan University College of Medicine. The semi-structured interviews were recorded and transcribed. Data were analyzed deductively and inductively using the Framework method of content analysis and our existing conceptual SDL model. Results: Our study showed that the essential themes across three SDL dimensions and six major steps in the process dimension in the contexts of Taiwan were compatible with the conceptual SDL model in our previous study in the U.S. While there were many similarities across the Taiwanese and American groups, some consistent differences emerged. When conducting SDL, American students tended to focus more on individual performance. Taiwanese students were strongly oriented to learning in a collaborative team and with their peers but avoided standing out when learning in a group. Conclusions: Our study contributes to the current SDL models with perspectives of the Taiwanese students and supports the applicability of ＂Person, Process, Context＂ dimensions of SDL. The findings in each SDL dimension also provide practical implications for clinical faculty and students in Taiwan.

全文請至下方連結下載：

http://dx.doi.org/10.6145%2fjme.202203_26(1).0002