基礎與臨床課程 之整合與落實,高雄醫學大學 醫學院 劉克明 副院長,2,Changing Face of Medical Curricula,Changes in medicine and society, Changes in focus of health care, Changes in curriculum design, Changes in curriculum content, Changes in curriculum delivery, Implementing curricular change Achieving change,R Jones et al. The Lancet 357, 699, 2001.,3,The Center of Effective Curriculum Reform,Leadership of change is essential, Balancing the need for academic stability, Groups of respected & skilled teachers, Excellent communication between staff & students, Feedback from students and patients. Rigorous evaluation of curriculum reform & educational interventions High-quality doctors delivering high-quality medical care.,4,Reforms in Medical Education,Recommended courses: Integrate teaching of basic sciences with clinical and social sciences, Make use of community and hospital healthcare settings, Increase overall patient contact, Provide greater student choice.,5,New Courses: To encourage learning method that directly link new knowledge to patient care, Modernize approaches to basic science (in particular anatomy), Increase emphasis on appropriate consultation skills and traditional learning, Promote a more human and supportive learning environment, To selecting candidates for medical education, To the assessments that underpin the direction of student learning.,6,Curriculum design,Integration: Integrate student learning by focusing on patients throughout the course, No traditional divide between clinical and non-clinical phases, nor between basic and applied science, Learning around desired outcomes & systemically rehearse clinical and technical skills through simulated & supervised “near life” situation, Aim to reduce apprenticeship “tag along with me” learning, which risks wide variation in student opportunities.,7,Student selection modules: to acquire critical appraisal and research skills, student selected modules: 30% of course time are draw on: social sciences and humanities, and professional fields such as law and health economics,8,Key units:,Being a Doctor, Being a Patient; 15 weeks Locomotion; 15 weeks Blood and skin; 12 weeks 4. Circulation; 12 weeks Respiration; 12 weeks Homeostasis and Hormones; 12 weeks The Senses; 12 weeks,9,Digestion and Nutrition; 12 weeks Reproduction; 14 weeks Growth and Development; 14 weeks The Elective; 8 weeks The Mind; 14 weeks Emergency Care; 14 weeks Preparation for Pre-Registration, 5 weeks,10,Student select study (SSS),Study of an area in detail: Each unit of the programme, student will take one of the following domains: a. Anatomy, b. Biochemistry & cell biology, c. Epidemiology, d. Ethics, e. Health Economics, f. Law, g. Physiology, h. Psychology, i. Sociology,11,Scientific method in medicine: Studies outside medicine: Language, b. Creative Writing, World Art, History (& History of Medicine), World Development, Linguistics, American Studies, Environmental Science, Risk and Decision Theory.,12,澳洲醫學委員會 （Australian Medical Council , AMC）,要求各醫學院之醫學教育目標，要發展 年輕醫師必備的知識、技巧與專業態度之特 質，才能安全有效的執行醫療，而且具備適 當基礎而能終身學習以及在任何醫學領域接 受進一歩訓練。,13,澳洲各醫學院依照AMC之要求，訂出 醫學教育的課程主題(Curriculum Themes)， 做為新課程的規劃與評量的骨架，也提供 醫學教育學程目標（Program Goals）的 骨架，亦即醫學生在修畢四年課程時， 應該要獲得之 最基本的知識、技能、態度、價值觀等， 以做為實習醫師之準備。,14,這四個課程主題的名稱雖然依不同醫學院而 有所差異，但其基本精神與重點都是一樣的。 雪梨大學醫學院之四個課程主題 （Curriculum Themes）為： Basic and Clinical Science Theme， Patient and Doctor Theme， Community and Doctor Theme， Personal and Professional Development Theme.,15,The Univ. of Sydney Medical Program Characterized by: a four-year graduate-entry web-based curriculum uses problem-based learning to enable students to become life-long learners, effective practitioners of contemporary medicine.,16,Features of the curriculum include: a student-centered approach; a focus on clinical reasoning; integration of subjects within opportunities for research.,17,Four themes extend throughout the four years of the University of Sydney Medical Program: basic and clinical science (50%), community and doctor (25%), patient and doctor (12.5%), personal and professional development (12.5%). The themes provide the framework for the goals of the program, the development of the curriculum and for assessment.,18,The relative contributions of the themes vary at different stages of the curriculum, with an initial focus on basic science and early clinical skills and a growing emphasis on clinical knowledge, skills and judgment.,19,three PBL (each 1.5 hrs.) Up to six lectures related to the weekly problem- issues relevant to all themes but with an emphasis on basic science, 3. two Basic and Clinical Science sessions ( generally 1.5 hrs), 4. two Patient and Doctor sessions ( up to1.5 hrs) in hospital, either one Community and Doctor or a Personal and Professional Development session or a joint session (1.5 hrs), one