科技部專題研究計畫主持人
MOST 107-2410-H-182-016-SSS
醫學生與醫師的模糊容忍度與專科選擇及專業生活品質的關係
Medical students and doctors\' tolerance of ambiguity: its association with specialty choices and professional quality of life.
科技部
Ministry of Science and Technology
長庚大學醫務管理學系(所)
Department of Health Care Management Chang Gung University
曾旭民
HSU-MIN TSENG
長庚大學醫務管理學系(所)
Department of Health Care Management Chang Gung University
鄭文婷
0989177653
chengtingting0531@gmail.com
計畫執行期間起:2018-08-01
計畫執行期間迄:2019-12-31
2019-02-01
2019-12-31
長庚醫院醫師及長庚大學醫學系學生
1
007
01
模糊容忍度;專科選擇;專業生活品質;醫學教育;醫師人力
tolerance of ambiguity;specialty choice;professional quality of life;medical education;physician manpower
背景: 醫療工作內容通常具有高度的不確定性與模糊度,主要因為知識的有限、診斷問題、治療複雜性、與病人反應的不可預測性等。醫師容忍模糊或不確定性的能力對於專科選擇、醫師的專業生活品質、與執醫行為有影響。然而受到此概念定義不一及缺乏適合當地文化的評估工具,使得探討醫學生與醫師的模糊忍受度的影響之相關研究受到限制。 目標: 透過結合模糊容忍度的測量與專科服務選擇的理論架構,此兩年期的計畫主要研究目標有二:1)採用晚近已經發展的國外醫學生與醫師模糊容忍度(TAMSAD)量表,翻譯並檢測其信度與效度;2)測試模糊容忍度與專科選擇有關的假設,並進一步檢驗對專科調適與專業生活品質之影響。 方法: 本研究為兩年期研究,共分為3個階段。階段一主要翻譯原來長版41題的TAMSAD 量表並據此建立題庫。預計問卷將回收200位醫學生的反應以檢驗此中文版問卷的心理計量特質,包括有信度與藉由比較高低年級得分差異的現行效標效度。階段二,調查90位不同專科的住院與主治醫師。所使用的工具主要測量概念包括有:個體的模糊忍受度;影響專科選擇的因素;與感知的專業生活品質。統計將以迴歸分析法來探討包括模糊容忍度在內的影響因子與專業生活品質之關係;階段三:以長期研究設計方法,訪談與調查30位兩年內年資之專科住院醫師,並於6個月 後測量其專科適應之結果,以驗證決策理論在專科選擇的模型及協助導入編制醫學生專科選擇之決策協助。 結論: 本計劃案將建構一份有效的TAMSAD中文版,並進一步確立模糊容忍度與專業選擇及工作上的福祉有關。由於模糊容忍度與專業選擇及專科環境調適歷程有關,因此如何透過醫學院的教育或訓練來增強醫學生或醫生應付模糊情境的能力,將是未來研究的重要課題。
BACKGROUND: Medical practice is inherently ambiguous and uncertain,arising from limitations of knowledge,diagnostic problems, complexities of treatment, and unpredictability of patient response. The physicians\'ability to tolerate ambiguity and uncertainty has been proved to associate with specialty choice, and to have a great impact on professional well-being and clinical practice. However, Research into medical students and doctors\' tolerance of ambiguity is hampered by poor clarity and inadequate measurement scales. OBJECTIVES: By integrating ambiguity tolerance assessment and specialty choice framework, this 2-years proposal aims to 1) to adapt a newly developed Tolerance of Ambiguity in Medical Students and Doctors (TAMSAD) scale and to pilot test its validity and reliability; 2) to test the hypothesis that ambiguity tolerance is associated with specialty choice among medical students and influences subsequent coping and professional quality of life among physicians. METHODS: This is a two-year project, consisted of three phases. In Phase 1, the original 41-items TAMSAD will be translated and employed as item pools for the development of ambiguity tolerance measure. A battery of questionnaires including TAMSAD will be developed and administered to 200 undergraduate medical students. Psychological properties such as reliability will be calculated and concurrent validity will be assessed by comparing TAMSAD scores differences between younger and senior students. The instrument will be used in the following studies to assess tolerance of ambiguity. In Phase 2, a total of 90 physicians from different medical specialties with different levels of expertise were administered a set of questionnaires measuring individual ability to tolerate ambiguity, personal factors affecting the choice of health specialty, and perceived levels of professional quality of life. A linear regression analysis will be performed to examine which variables predict the professional quality of life. In Phase 3, a longitudinal research design methodology will be used to investigate the fit of decision theory to specialty choice. Thirty residents limited to 2-year seniority will be interviewed and surveyed with the insight from the results of previous phases. After 6 months, they will be surveyed again to investigate their adaptation process of specialty practice. The results will help to validate the decision-making theory and to give suggestion for making decision aid aiming at the preparation of specialist choice for medical students The decision-making assistance. CONCLUSIONS: This project will help to develop a Traditional Chinese version of ambiguity tolerance for medical students and doctors, and to demonstrate the influence of ambiguity tolerance on specialty choice and work-related well being. Findings from the present study will have important implications for medical education and physician allocation. Given the important role of ability to tolerate ambiguity has on specialty choice and subsequent work-related coping process, it would be worth paying particular attention to such a skill in medical education settings.
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