Study on the Repetitive Innovation of Medical Education in a Medical University

培育優質之醫師影響醫療照護品質進而攸關國人全面健康之提昇。隨著經濟發展及社會進步，過去單純之醫療環境漸趨複雜。醫學大學之醫學系肩負醫學生畢業前之醫學教育，更需要與時俱進，不斷創新，以符合民眾及社會期待。 台北醫學大學醫學系自2009年起，依循整合、多元、自主之理念，對醫學系展開課程變革。其中三至四年級由原本之學科主導授課，改為器官系統為主之整合課程，內容貫穿融合基礎與臨床內容。五年級上學期增加47項臨床核心技能課程及核心技能臨床案例討論，讓同學及早接觸醫院之教學環境。六年級進入醫院後，新增整合客觀結構式臨床技能測驗iOSCE (integrated objective structured clinical examination)教學，結合標準化病人及電腦自學軟體。七年級亦新增跨領域團隊合作訓練TRM(team resource management)，包括小組討論及模擬演練，使同學熟悉臨床情境。利用質、量性分析方法，我們發現醫學系課程變革對clerkship (五至六年級)的效用較明顯。而整合課程滿意度較高之同學，和一階國考通過比例成有意義之正相關。 本研究亦運用VPS (vision, positioning, scenario)創新循環理論，來說明醫學生於畢業前包括進入醫院前、後之醫學教育改革。在跳脫現今思維、化不可能為可能、物超所值之理念下，應用VPS創新循環不斷提升。最後，利用價值創新循環(value creation cycle)，說明在現今醫療之作業環境下，未來如何充分掌握醫療與資訊科技的發展、利用雲端趨勢、社群分享、協同合作，發現創新的泉源，規劃及落實住院醫師及醫學生訓練，持續不斷的發現、創造、及實現價值循環。Cultivating high standard physician affects quality of patient care and subsequently health promotion to our fellow citizens. Along with the economic development and social progress, the health care environment is becoming more complex. School of medicine of medical university is responsible for the medical education before medical student graduation. Therefore, to meet the people and social expectations, it is imperative that school of medicine requires constant progress and innovation. Under the ideas of integration, multivariate, and self-directed learning, curriculum reform in School of Medicine of Taipei Medical University was started since 2009. Multi-disciplinary curriculum for year 3-4 medical students was shifted into organ-system-based curriculum which integrated basic and clinical knowledge. To let the year 5 medical students encounter the clinical environment earlier, 47 core clinical skills and case-based discussion curriculum were engaged in our teaching hospitals. Novel iOSCE which combined standardized patients and computer programs was added for the year 6 medical students to promote self-direct learning. TRM which includes small group discussion and simulation programs was implicated for the year 7 medical students to familiar with real clinical situations. Using qualitative and quantitative methods, we demonstrate that curriculum reform in School of Medicine of TMU is more effective for clerkship (year 5-6) students. Moreover, for the clerkship, the course satisfaction is significantly associated with the increased passing rate for the stage one national physician examination of Taiwan. In this study, we also apply VPS (vision, positioning, scenario) innovation theory to demonstrate the feasibility of medical education reform for medical students either learning at school or hospital before graduation. The vision, position, and scenario of our curriculum reform fit the cores of innovation: 「Never thought of before」,「Impossible makes possible」 and 「Heart-touching」, respectively. Finally, under present health care environment, we examine the advances of medical care and information technology, the trend of cloud infrastructure development, and the possibility of social sharing and online collaboration to explore the sources for repetitive innovations. We then use value creation cycle to show how we plan and implement the future training for residents and medical students with the notion that the discovery, creation and realization of value will be a continued cycling process