{"id":235,"date":"2019-07-23T09:12:43","date_gmt":"2019-07-23T01:12:43","guid":{"rendered":"https:\/\/lic.kmu.edu.tw\/?p=235"},"modified":"2019-10-21T09:11:47","modified_gmt":"2019-10-21T01:11:47","slug":"%e5%8f%b0%e7%81%a3%e9%86%ab%e5%ad%b8%e6%95%99%e8%82%b2%e5%ad%b8%e6%9c%83%e9%9b%bb%e5%ad%90%e5%a0%b1%e7%ac%ac20%e6%9c%9f%e6%96%87%e7%ab%a0%e7%99%bc%e8%a1%a8%ef%bc%9a%e3%80%8c%e7%b8%b1%e8%b2%ab%e6%95%b4","status":"publish","type":"post","link":"https:\/\/lic.kmu.edu.tw\/?p=235","title":{"rendered":"\u53f0\u7063\u91ab\u5b78\u6559\u80b2\u5b78\u6703\u96fb\u5b50\u5831\u7b2c20\u671f\u6587\u7ae0\u767c\u8868\uff1a\u300c\u7e31\u8cab\u6574\u5408\u6027\u81e8\u5e8a\u5be6\u7fd2\u300d(Longitudinal Integrated Clerkship)\u5171\u5b78\u5171\u7167\u6a21\u5f0f\u5728\u9ad8\u91ab"},"content":{"rendered":"\n

\u7e31\u8cab\u6574\u5408\u6027\u81e8\u5e8a\u5be6\u7fd2\u300d(Longitudinal Integrated Clerkship)\u5171\u5b78\u5171\u7167\u6a21\u5f0f\u5728\u9ad8\u91ab<\/strong> <\/p>\n\n\n\n

\u9ad8\u96c4\u91ab\u5b78\u5927\u5b78\u91ab\u5b78\u9662\u66a8\u9644\u8a2d\u91ab\u9662\u4e00\u822c\u91ab\u5b78\u5167\u79d1
\u674e\u667a\u96c4\u4e3b\u4efb
\u9ad8\u96c4\u91ab\u5b78\u5927\u5b78\u91ab\u5b78\u9662\u66a8\u9644\u8a2d\u91ab\u9662\u5167\u79d1\u90e8
\u8521\u54f2\u5609\u6559\u6388<\/strong><\/p>\n\n\n\n

\u524d\u8a00\u2500\u50b3\u7d71\u81e8\u5e8a\u5be6\u7fd2\u5236\u5ea6\u4e4b\u6311\u6230<\/strong><\/p>\n\n\n\n

\u73fe\u4ee3\u91ab\u5e2b\u57f9\u80b2\u4e4b\u81e8\u5e8a\u6559\u80b2\u8a13\u7df4\u76ee\u6a19\u4e3b\u8981\u662f\u8b93\u5be6\u7fd2\u91ab\u5b78\u751f\u6709\u6a5f\u6703\u5728\u91ab\u9662\u53c3\u8207\u81e8\u5e8a\u7167\u8b77\u8207\u5be6\u5730\u64cd\u4f5c\uff0c\u5728\u76e3\u7763\u4e0b\u5c07\u91ab\u5b78\u77e5\u8b58\u6b63\u78ba\u5730\u3001\u9069\u7576\u5730\u904b\u7528\u5728\u75c5\u4eba\u8eab\u4e0a\uff0c\u89e3\u6c7a\u75c5\u4eba\u7684\u75c5\u75db\uff0c\u540c\u6642\u91ab\u5b78\u751f\u7372\u53d6\u70ba\u672a\u4f86\u884c\u91ab\u6e96\u5099\u7684\u6838\u5fc3\u80fd\u529b\u3002\u7136\u800c\u73fe\u4eca\u81e8\u5e8a\u5be6\u7fd2\u91ab\u5b78\u751f\u5236\u5ea6(Clerkship)\u8a13\u7df4\u6a21\u5f0f\uff0c\u56e0\u61c9\u91ab\u7642\u9ad4\u7cfb\u8207\u793e\u6703\u8b8a\u9077\u9762\u81e8\u9ad8\u5ea6\u6311\u6230\uff0c\u50b3\u7d71\u63a1\u7528\u6a21\u7d44\u8f2a\u8a13\u81e8\u5e8a\u5be6\u7fd2\u5236\u5ea6\u6a21\u5f0f(Traditional block rotation clerkship, TBR)\uff0c\u5728\u5404\u81e8\u5e8a\u79d1\u8f2a\u8a13\u6642\u9593\u7d042-3\u9031\uff0c\u5176\u7f3a\u9ede\u662f\u5b78\u7fd2\u5834\u57df\u4fb7\u9650\u65bc\u91ab\u9662\u70ba\u4e3b\uff0c\u904e\u5ea6\u5c08\u79d1\u5c0e\u5411\uff0c\u91ab\u5b78\u751f\u8207\u4f4f\u9662\u75c5\u4eba\u7167\u9867\u671f\u9593\u53ca\u91ab\u7642\u5718\u968a\u4e92\u52d5\u7686\u4e0d\u8db3\uff0c\u56e0\u6b64\u53ef\u80fd\u906d\u90472010\u5e74\u5361\u5167\u57fa\u7814\u7a76\u5831\u544a\u6240\u5217\u8209\u4e4b\u7f3a\u5931\uff1a\u7f3a\u4e4f\u77e5\u8b58\u8207\u7d93\u9a57\u6574\u5408\uff0c\u7121\u6cd5\u5ef6\u7e8c\u6027\u5718\u968a\u7167\u9867\uff0c\u5c08\u696d\u50f9\u503c\u767c\u5c55\u4e0d\u8db3\u7b49\u6311\u6230\u3002<\/p>\n\n\n\n

\u7e31\u8cab\u6574\u5408\u6027\u81e8\u5e8a\u5be6\u7fd2 (Longitudinal Integrated Clerkship, LIC) \u4e4b\u5c0e\u5165<\/strong><\/p>\n\n\n\n

\u70ba\u4e86\u56e0\u61c9\u5b78\u7fd2\u8005\u7684\u9700\u8981\u8207\u75c5\u4eba\u54c1\u8cea\u78ba\u4fdd\u7684\u6311\u6230\uff0cHirsh\u57282007\u5e74\u5021\u8b70\u300c\u5ef6\u7e8c\u6027\u300d(continuing)\u70ba\u81e8\u5e8a\u6559\u80b2\u6539\u9769\u7684\u6307\u5c0e\u539f\u5247\uff0c\u9996\u5148\u5728\u54c8\u4f5b\u91ab\u5b78\u9662\uff0c\u5f8c\u7e8c\u5728\u7f8e\u52a0\u5730\u5340\u6578\u5bb6\u91ab\u5b78\u9662\uff0c\u898f\u5283\u5be6\u65bd\u4e0d\u540c\u6a21\u5f0f\u7684\u300c\u7e31\u8cab\u6574\u5408\u6027\u81e8\u5e8a\u5be6\u7fd2\u300d(Longitudinal Integrated Clerkship, LIC) <\/strong>\u5236\u5ea6\u8a13\u7df4\u6a21\u5f0f\uff0c\u6b64LIC\u5236\u5ea6\u4e4b\u6838\u5fc3\u8981\u7d20\u5305\u62ec\uff1a 1.\u91ab\u5b78\u751f\u8207\u75c5\u4eba\u53ca\u670d\u52d9\u5834\u57df\u5efa\u7acb\u4ee5\u75c5\u4eba\u70ba\u4e2d\u5fc3\u7684\u9577\u9060\u5ef6\u7e8c\u7167\u8b77\u95dc\u4fc2(continuity of care)\uff0c2.\u8207\u6307\u5c0e\u8001\u5e2b\u5efa\u7acb\u9577\u9060\u5ef6\u7e8c\u95dc\u4fc2(continuity of supervision)\uff0c3.\u8207\u540c\u5115\u5b78\u7fd2\u793e\u7fa4\u5efa\u7acb\u5ef6\u7e8c\u95dc\u4fc2(a continuous learning community of peer learners)\uff0c4.\u8ab2\u7a0b\u5ef6\u7e8c\u6027(continuity of curriculum)\uff0c5.\u91ab\u7642\u9ad4\u7cfb\u8a13\u7df4\u5ef6\u7e8c\u6027(continuity of systems)\u3002\u5f37\u8abf\u85c9\u7531\u540c\u5115\u8207\u81e8\u5e8a\u8de8\u9818\u57df\u5718\u968a\u5b78\u7fd2\u7db2\u7d61\u793e\u7fa4\uff0c\u63d0\u4f9b\u5f48\u6027\u591a\u5143\u5316\u5b78\u7fd2\u6a5f\u6703\uff0c\u5efa\u69cb\u81e8\u5e8a\u5be6\u52d9\u7d93\u9a57\u8207\u6838\u5fc3\u80fd\u529b\uff0c\u540c\u6642\u91cd\u8996\u5c08\u696d\u7d20\u990a\u57f9\u80b2\u3001\u6e9d\u901a\u6280\u5de7\u8207\u5718\u968a\u5408\u4f5c\u4e4b\u96b1\u85cf\u8ab2\u7a0b\uff0c\u671f\u5f85\u5f9e\u7562\u696d\u524d\u5b78\u7fd2\u5230\u7562\u696d\u5f8c\u57f7\u696d\u9806\u66a2\u929c\u63a5\uff0c\u6301\u7e8c\u5728\u5236\u5ea6\u4e0b\u4e4b\u81e8\u5e8a\u5de5\u4f5c\u4e2d\u5b78\u7fd2(System-based practice) \u3002<\/p>\n\n\n\n

LIC\u5236\u5ea6\u8a13\u7df4\u6a21\u5f0f\u5be6\u65bd\u6210\u6548:\u570b\u969b\u6587\u737b\u5831\u544a<\/strong><\/p>\n\n\n\n

LIC\u5236\u5ea6\u5728\u570b\u969b\u5404\u8457\u540d\u5927\u5b78\u5df2\u6709\u591a\u5e74\u7d93\u9a57\uff0c\u6587\u737b\u5831\u544a\u986f\u793a\u5c0d\u91ab\u5b78\u751f\u3001\u6559\u5e2b\u3001\u75c5\u4eba\u53ca\u793e\u5340\u7686\u6709\u6b63\u9762\u6548\u76ca\u3002<\/p>\n\n\n\n

(1) \u5b78\u751f\u8868\u73fe\uff1a\u53c3\u8207LIC\u5b78\u54e1\u8207\u50b3\u7d71\u81e8\u5e8a\u5be6\u7fd2\u5236\u5ea6\u6bd4\u8f03\uff0c\u66f4\u5177\u5099\u540c\u7406\u5fc3\u3001\u5c08\u696d\u614b\u5ea6\u8207\u502b\u7406\u50f9\u503c\u89c0\uff0c\u80fd\u6df1\u5165\u4e86\u89e3\u75c5\u4eba\u7684\u300c\u751f\u7406\u3001\u5fc3\u7406\u3001\u793e\u6703\u300d\u5c64\u9762\u4e4b\u5f71\u97ff\uff0c\u5c0a\u91cd\u5404\u8077\u985e\u5728\u8de8\u9818\u57df\u5718\u968a\u904b\u4f5c\u4e4b\u5c08\u696d\u89d2\u8272\u3002LIC\u5b78\u54e1\u900f\u904e\u7167\u9867\u75c5\u4eba\u8cac\u4efb\u52a0\u91cd\uff0c\u6df1\u5165\u81e8\u5e8a\u5de5\u4f5c\u8207\u5b78\u7fd2\u793e\u7fa4\u6838\u5fc3\uff0c\u4fc3\u4f7f\u5b78\u751f\u7372\u53d6\u81e8\u5e8a\u5fc5\u8981\u6838\u5fc3\u80fd\u529b\uff0c\u4ee5\u53ca\u5c08\u696d\u89d2\u8272\u8a8d\u77e5\u5f62\u6210\u3002<\/p>\n\n\n\n

(2) \u75c5\u4eba\u7167\u8b77\u54c1\u8cea\u8207\u793e\u5340\u91ab\u7642\u4e4b\u6210\u6548\uff1aLIC\u5b78\u54e1\u8207\u75c5\u4eba\u5efa\u7acb\u66f4\u9577\u9060\u6df1\u5165\u95dc\u4fc2\uff0c\u7d66\u4e88\u500b\u5225\u5316\u9700\u6c42\u7684\u7167\u9867\u3002\u75c5\u4eba\u56de\u994b\u986f\u793aLIC\u5b78\u54e1\u66f4\u6709\u793e\u6703\u8cac\u4efb\u611f\uff0c\u626e\u6f14\u793e\u5340\u91ab\u7642\u670d\u52d9\u8207\u5065\u5eb7\u4fc3\u9032\u8005\u4e4b\u91cd\u8981\u89d2\u8272\u3002<\/p>\n\n\n\n

(3) \u6559\u5e2b\u8207\u91ab\u7642\u5718\u968a\u4e4b\u6210\u6548\uff1a\u53c3\u8207LIC\u8a08\u756b\u81e8\u5e8a\u6559\u5e2b\u8207\u91ab\u5b78\u751f\u6df1\u5165\u4e92\u52d5\uff0c\u6559\u5e2b\u81ea\u8a55\u6eff\u610f\u5ea6\u8207\u50f9\u503c\u89c0\u63d0\u5347\uff0c\u4fc3\u9032\u8de8\u9818\u57df\u5718\u968a\u5b78\u7fd2\u6210\u6548\u3002 <\/p>\n\n\n\n

\u300cLIC\u5171\u5b78\u5171\u7167\u6a21\u5f0f\u300d\u5728\u9ad8\u91ab\u5be6\u65bd\u73fe\u6cc1\u8207\u521d\u6b65\u6210\u6548<\/strong><\/p>\n\n\n\n

\u9ad8\u96c4\u91ab\u5b78\u5927\u5b78\u9644\u8a2d\u91ab\u9662\u57282018\u5e74\u8d77\uff0c\u5728\u79d1\u6280\u90e8\u91ab\u5b78\u6559\u80b2\u7814\u7a76\u8a08\u756b\u88dc\u52a9\u4e0b\uff0c\u57fa\u65bc\u300c\u4ee5\u75c5\u4eba\u70ba\u4e2d\u5fc3\u7167\u9867\uff0c\u5be6\u7fd2\u91ab\u5b78\u751f\u80fd\u529b\u70ba\u5c0e\u5411\u300d\u4e4b\u6559\u80b2\u8a13\u7df4\u76ee\u7684\uff0c\u4ee5\u81e8\u5e8a\u6559\u80b2\u8a13\u7df4\u4e4b\u4e09\u5927\u9762\u5411\uff0d\u300c\u5b78\u7fd2\u3001\u7167\u9867\u3001\u7763\u5c0e\u4e4b\u5ef6\u7e8c\u6027\u300d(Continuity of Learning, Care, and Supervision)<\/strong> \u70ba\u8ab2\u7a0b\u8a2d\u8a08\u4e4b\u6838\u5fc3\u6982\u5ff5\uff0c\u898f\u5283\u57f7\u884c\u9069\u5408\u53f0\u7063\u570b\u60c5\u6587\u5316\u7684\u300c\u7e31\u8cab\u6574\u5408\u6027\u81e8\u5e8a\u5be6\u7fd2\u300d(LIC) \u4e4b\u81e8\u5e8a\u6559\u80b2\u5275\u65b0\u6a21\u5f0f\u8ab2\u7a0b\u3002 <\/p>\n\n\n\n

\u9ad8\u91abLIC\u6a21\u5f0f\u5f37\u8abf\u300c\u5c0a\u91cd\u5b78\u54e1\u81ea\u4e3b\u6027\u8207\u9f13\u52f5\u81ea\u6211\u5c0e\u5411\u5b78\u7fd2\u300d\uff0c\u76ee\u524d\u57f7\u884c\u6b65\u9a5f\u662f\uff1a(1) \u5171\u670939\u4f4dClerks\u5b78\u54e1(\u91ab\u5b78\u7cfb28\u4f4d\u3001\u5f8c\u91ab\u7cfb11\u4f4d)\u900f\u904e\u5a92\u5408\u6a5f\u5236\uff0c\u9078\u64c72-3\u4f4d\u4e0d\u540c\u79d1\u5225\u8001\u5e2b\u70ba\u81e8\u5e8a\u5c0e\u5e2b(Preceptors)\uff0c\u4e26\u8207\u540c\u5115Clerks \u5f62\u6210\u5171\u540c\u5b78\u7fd2\u8207\u7167\u9867\u4e4b\u5925\u4f34\uff0c(2) \u81e8\u5e8a\u5c0e\u5e2b\u9078\u64c7\u9069\u5408\u9577\u671f\u7167\u9867\u8ffd\u8e64\u75c5\u4eba\uff0c\u5fb5\u6c42\u540c\u610f\u5f8c\u4f5c\u70baClerk\u70ba\u9577\u671f\u8ffd\u8e64\u7167\u9867\u7684\u300c\u75c5\u53cb\u826f\u5e2b\u300d\uff0c\u5728\u81e8\u5e8a\u5c0e\u5e2b\u7763\u5c0e\u4e0b\uff0c\u8207\u75c5\u4eba\u5efa\u7acb\u9577\u9060\u7167\u9867\u95dc\u4fc2\uff0c\u5171\u540c\u5b78\u7fd2\u63d0\u4f9b\u75c5\u53cb\u6574\u5408\u5168\u4eba\u7167\u9867\uff0c\u4e26\u589e\u9032\u5b78\u54e1\u81ea\u6211\u81e8\u5e8a\u6838\u5fc3\u80fd\u529b\u3002 (2) \u5a92\u5408\u914d\u5c0d\u5f8c\u6bcf\u4f4d\u5c0e\u5e2b\u5e36\u9818\u4e09\u7d042-4\u4f4d\u5b78\u54e1\uff0c\u6bcf\u6708\u805a\u6703\u4e00\u6b21\u5f62\u6210\u540c\u5115\u5171\u5b78\u5171\u7167\u793e\u7fa4\u9032\u884c\u540c\u5115\u5b78\u7fd2\u3002\u53e6\u5916\u6210\u7acb\u516d\u500b\u5bb6\uff0c\u6bcf\u5bb6\u7531\u5bb6\u5c0e\u5e2b(Mentors) \u5e36\u9818\uff0c\u6bcf\u6708\u805a\u6703\u4e00\u6b21\uff0c\u5171\u540c\u5206\u4eab\u53cd\u601dLIC\u6a21\u5f0f\u4e4b\u5b78\u7fd2\u8207\u7167\u9867\u9032\u5c55\u3002\u672c\u8a08\u756b\u63a1\u7528\u884c\u52d5\u7814\u7a76\u6a21\u5f0f\uff0c\u9080\u8acb\u81e8\u5e8a\u6559\u5e2b\u8207Clerks\u5b78\u54e1\u4e3b\u52d5\u53c3\u8207LIC\u8ab2\u7a0b\u898f\u756b\u8a13\u7df4\u6a21\u5f0f\u8207\u57f7\u884c\u6210\u6548\u8a55\u4f30\u6aa2\u8a0e\u4e4b\u6301\u7e8c\u6539\u5584\u5faa\u74b0\u3002 <\/p>\n\n\n\n

\u5b78\u54e1\u8a8d\u77e5(N=28\/39)\u986f\u793aLIC\u5171\u5b78\u5171\u7167\u6a21\u5f0f\u5be6\u65bd\u521d\u6b65\u6210\u6548\uff1a (1)\u75c5\u53cb\u53ca\u5bb6\u5c6c\u7d66\u4e88\u5b78\u54e1\u53cb\u5584\u652f\u6301\u7684\u7a0b\u5ea68.8 \u00b1 1.2(\/10\u5206)\uff0c\u8207\u81e8\u5e8a\u6559\u5e2b\u4e92\u52d5\u6216\u63a5\u53d7\u6307\u5c0e\u6642\u7d66\u4e88\u5b78\u54e1\u53cb\u5584\u652f\u6301\u7684\u7a0b\u5ea69.8 \u00b1 0.6 (\/10\u5206)\uff0cLIC\u6a21\u5f0f\u7372\u5f97\u6b63\u9762\u5b78\u7fd2\u6548\u76ca\u6392\u540d\u6700\u9ad8\u9805\u76ee\u5305\u62ec\uff1a1.\u6e9d\u901a\u6280\u5de7\u30012.\u4e86\u89e3\u793e\u6703\u5fc3\u7406\u5f71\u97ff\u56e0\u7d20\u30013.\u81e8\u5e8a\u77e5\u8b58\u30014.\u75c5\u53f2\u8a62\u554f\u30015.\u5c08\u696d\u614b\u5ea6\uff0c\u5176\u4e2d\u6709\u56db\u9805\u8207\u81e8\u5e8a\u6559\u5e2b\u8a8d\u77e5\u7d50\u679c\u76f8\u540c\u3002<\/p>\n\n\n\n

\u7d50\u8a9e<\/strong><\/p>\n\n\n\n

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  2. Hirsh DA, Ogur B, Thibault GE, Cox M. “Continuity” as an organizing principle for clinical education reform. N Engl J Med. 2007;356(8):858-66.<\/li>
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  4. Poncelet AN, Mazotti LA, Blumberg B, Wamsley MA, Grennan T, Shore WB. Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system. The Permanente Journal. 2014;18(2):50-6.<\/li>
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