社團法人臺灣臨床藥學會

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【綜合評述】實證醫學系列:實證醫學教學與評量
Evidence-Based Medicine Series: How to Teach and Evaluate It
實證醫學、教學評量、實證醫學競賽、Evidence-Based Medicine, Competency Evaluation, EBM Competition
劉人瑋Jen-Wei Liu* 、王春玉Chun-Yu Wang
1新光醫療財團法人新光吳火獅紀念醫院藥劑部
實證醫學(evidence-based medicine, EBM) 是結合臨床問題、病患價值、研究證據與臨床經驗的學問。應用實證醫學解決臨床問題已是西方醫學的主軸,因此醫療人員都需具備實證醫學技巧。實證醫學的教學模式可分為親身示範、編入教材、教授特定實證技巧及期刊討論會。不論使用任何模式,導師都要注意避免教授如何「進行研究」遠多於如何應用研究、教授如何「進行統計」遠多於如何闡釋等盲點。小組討論是教授實證醫學最好的教學方法,成功的討論建立於專心和流暢的意見交流,導師可利用技巧維持討論進行和處理歧見。小組討論常見問題還包括專業術語(jargon)、數字問題、統計分析和虛無主義,經由適當的引導和討論,學員和導師都能從小組討論中釐清觀念和練習應用。教學評量方式包含開放性的文字問題、填空題與數據計算、根據標準場景建立的複選題等,教學者亦可自行開發學習記錄單。參與文獻查證競賽即是實踐實證手法的縮影,參賽對學員和導師都有幫助。目前競賽更著重臨床應用與成效評估,讓實證醫學更加融入臨床醫療。
 
Evidence-based medicine (EBM) is the integration of research evidence with clinical question, clinical experience and patient values. EBM is indispensable in education of health care professionals. Modes of education include role modeling, weaving evidence into clinical teaching, targeting specific skills and journal club. Teachers should be aware of blind spots in teaching EBM, such as explaining statistics without showing how to apply statics to medical decision. Small group discussion is a successful way to encourage learners to think and share their thoughts. Teachers should guide the team to keep a focused discussion and resolve disagreements rationally. For evaluation, teachers can use developed tools or design learning sheet. Learning sheet include all the steps of EBM. In the step of applying evidence, teacher should guide learners to integrate evidence with available resource, discuss with patients in plain language and grade confidence of evidence. Learning sheet is useful for discussing with learners and documenting learning progress. Participating in EBM competition is positive for learners and teachers. For learners, observing other team’s performance could provoke self-awareness. For teachers, they could observe learner’s presentation and adjust teaching method. Nationwide competition such as Healthcare Quality Improvement Campaign (HQIC) could motivate health care professionals to apply EBM in practice and improve their skills.
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