1、David C.Y. Kwan Ph.D.,Dept of MedicineMcMaster University, Canada and China Medical University, Taichung, Taiwan,教師成長中心 國際交流中心 中國醫藥大學,Cell Physiology,Receptor Pharmacology,Pathophysiology,Natural Products,教育,醫護,PBL,We teach students medicine, but do they learn?,易,Modified from The Scientist 16, 2002
2、,包羅萬象炎,Coveritis,Curriculomegaly,The root of the traditional problem !,課程肥大症,全球的傳統式醫學教育 半世紀以來己遇到很難 解決且日益嚴重的困境,1知識暴漲Knowledge explosion 2過度專業Excessive specialization 3被動學習Passive learning 4知行脫節Lack of relevance 5倫理沒落Diminishing ethics,大刀闊斧的醫教改革已 是務急必行且刻不容緩,Traditional teaching is facing dead-ends,Inn
3、ovative reform is inevitable,倫理教育 Education in ethics,Who?,What?,When?,How?,Physiology,Biochemistry,Anatomy,Community Med,Microbiology,Pharmacology,Internal Med,Surgery,科目多元化,人文,倫理,1. 醫學倫理的思考 2. 病人為中心 的倫理思維 3. 病人的隱私與醫師的守秘 4. 青少年性的迷思與墮胎的省思 5. 代理孕母的衝擊 6. 智障者有生育的權利嗎？ 7. 從醫學倫理看複製人 8. 人體試驗與醫學研究 9. 要不要用安慰
4、劑 10. 幫人安樂死，有罪嗎？ 11. 生命與死亡,戴正德教授授課 醫學系四年級,Didactic lecture ?,Interactive lecture ?,Imposed? or Self-directed?,醫學系一、二年級：醫學電影欣賞與討論，PBL四年級：醫學社會學模組 (整合課程4205)lectures, 影片欣賞、小組討論，PBL六、七年級：醫學倫理演講與實例小組討論,中國醫藥大學 醫學倫理教學,PBL,現代醫學教育 的崇高之境界,Kwan C.Y. (關超然) China Medical University, (台中) / McMaster University, (
5、加拿大),Why PBL ?,Reducing lecture time & breaking away from traditional shortcomings Explore, identify, analyze & solve problems with evidence-based approach Team-work spirit with effective communication & interpersonal skills Self-directed learning leading to life-long learning personalize, socialize
6、 & globalize,Taiwan 2004,在醫學教育上有效的應用 Apply to the study of medicine,成人教育的理念 Adult Learning,大學之道在明明德,全人教育的化身 Holistic learning,子以四教，文，行，忠，信,終身教育的準備 Life-long learning,三十而立七十而 從心 所欲不越矩,PBL,以問題為導向的醫學教育 是建立在人文素養的基礎上 PBL in medical education is about “human”,What is PBL in medicine Where ethics fits in?,
7、傳統,Tradition,以書本及考試 來導向 學習,基礎,臨床,傳統,1 + 1 = 2,人文,人文,醫學,組合,倫理,倫理,Innovation,以情境及問題 來導向 學習,創新,Anatomy,Biochemistry,Physiology,Pharmacology,Pathology,Surgery,Humanity,Social order,Community Health,Illness,基礎,臨床,1 + 1 = 10,醫學,人文,人文,人文,人文,人文,整合,倫理,倫理,倫理,倫理,How to integrate learning issues in a PBL proble
8、m ?,Understand basic science,功能與結構 生理與心理 藥物與機制 生育長老死,PBL,Vertical integration,Horizontal integration,Clinically applicable and relevant,PBL的目的就是教育的目的:,To know To do To be,知識 技能 態度,Initial knowledge,Professional competency,稱職,知識,“明日醫師”應有的學習及行醫素質,Broad spectrum of knowledge/skills 博學多能 Good problem-so
9、lving skills 解決問題 Good team/corporate spirit 團隊精神 Appropriate professional behavior 專業操守 Effective communication skills 溝通技巧 Self-directed learning skills 自主學習to lead to life-long learning 終身學習,以上的學習素質應該需要分開基礎與臨床二方面嗎？或者明日中西醫師需要的學習素質不同嗎？,舊,新,How to do PBL with ethics in real life ?,Passive learning i
10、n the large classroom via didactic lectures,Active learning in small groups simulating the real workplace,NUS,NUS,HKU,Small Group Tutorial,Professional behavior 專業操守 Self-directed learning自主學習 Team-work spirit 團隊精神 Communication skills 溝通技巧,Unit-2 March, 2000,PBL,Regrouping of students occurs for ea
11、ch unit, no 2 students will be in the same group in more than 1 unit through out their medical education,自主學習,小組討論,using simulated paper patient scenarios,尋找資料精研細讀,討論砌磋切問討教,反省回饋有錯必改,Problem-exploration: to understand, to define, to search, to analyze and to synthesize,Problem-solving: to exchange, t
12、o discuss, to refine, to change, to add and to conclude,腦力激盪設訂目標,A functioning grouplooks like this ,Offer your reassurance,和諧且互動,Be interested,and inquisitive ,Show your enthusiasm,切問而近思,Show your supportand do your share ,Show students that you care,互輔並互助,四歲大的小華被媽媽帶來醫院燒傷急診室求醫。小華半邊身自腰部以下的皮膚都可看到嚴重紅腫
13、及燙傷的大水泡。小華疼痛得尖聲哭叫。這位二十一歲的單親媽媽對醫生解釋說小華太頑皮常常帶給她很多麻煩，這次他又不小心打翻餐桌上的熱水壺燙傷了自己。可是小華哭著說：不是我，我沒有打翻熱水壺！是媽媽倒翻的！,小華燙傷了,醫學生，實習醫生，住院醫生，護士，社會工作者或般人可以 從這個案例學些什麼？,What do students learn from this problem? 皮膚燙傷案例,器官 組織解剖 skin, nerve,生理 Acid/base, Ionic balance pain,病理 Inflammation necrosis,藥理 Pain killer, Topical Tre
14、atment, Skin graft,社區醫學 Child care against burn,社會，心理 行為 Child-abuse, behavior,醫療體制 Burn-unit,倫理： 意識形態 規則價值,社會，家庭， 醫學，個人,A deadly mistake,A deadly mistake,A case in point: how a simple operating room mix-up led to a tragic death of a boy called Ben not all that unusual.,Like so many other kids, youn
15、g Ben, 7, had a history of ear problems. Hed already had two operations as a toddler, and then, six years ago, he needed another one to remove a benign growth inside his ear an operation that his father,Tim Kolb, was told by the doctors was routine. On the day of operation, at 10 a.m., Ben was wheel
16、ed into the operating room. At 10:30, 20 minutes after an anesthesiologist had put Ben to sleep, his surgeon gave him a series of injections around his ear the drug lidocaine, which is a local anesthetic. The actual ear surgery hadnt even begun at this point but just two minutes later, Ben was in cr
17、isis. His vital signs were grossly abnormal with very high blood pressure and very high heart rate.” Anesthesiologist McLain who hadnt been involved in Bens surgery until that point couldnt explain why he was having this severe a reaction to a lidocaine injection. But he knew he had to get Bens vita
18、l signs under control fast. He gave Ben a series of drugs that within moments restored his heart rate and blood pressure back down toward normal. All signs had returned to normal and he looked very stable. And the surgical team decided to continue. But just moments later, Dr. McLain was summoned bac
19、k to the O.R. This time, Bens vital signs had plunged below normal and collapsed in a deadly free-fall with a flatline EKG complex. They did the CPR for 90 min and eventually resuscitated Ben. His heart was beating on his own, but Ben was comatose and on a ventilator. The next day, Ben died.,Laborat
20、ory test of the remains from the syringe used for lidocaine revealed that the content in the syringe was adrenaline, not lidocaine.,What is lidocaine ? What is its mechanism of action? What is adrenaline and how is it used surgical operation? What is the likely scenario for the mixed-up in the O.R.?
21、 What could be done to prevent this from happen again?,PBL,Lets review the lessons learned,PBL的目的就是 教育的目的:,To know To do To be,求知 力行 做人,S3-1 國際學術交流,關超然教授兼主任,P2,張永賢副校長、關超然教授、梁育民副教授,理論,以學生為中心 以問題為導向,博學多能 解決問題 團隊精神 專業操守 溝通技巧 自主學習終身學習,Problem-based learning Population, behavior, life Pupil-based learnin
22、g Profession-based learning Project-based learning Proficiency-based learning Process-based learning Properly-balanced learning Passion based learning,程過,培育學生 自主學習 訓練老師 協導學習,Tutor facilitates,Students in action,情境學習而非授課 小組討論而非聽課 Learning in context,三人行必有我師焉 切問而近思 不恥下問,P2,欲達到現代高等教育 最崇高境界 必需從自主學習 昇華至終
23、身學習,Outcome of PBL,PBL makes learning more satisfactory and fun for students and teachers. PBL students use more resources and study for a longer period. PBL students have a longer retention time for knowledge recall. PBL students demonstrate more characters as life-long learners in the workforce.,I
24、f properly done, PBL does NOT have a negative impact on teachers academic career. PBL dose NOT reduce/narrow the scope of the knowledge content acquired. Medical schools using PBL do NOT have reduced national examination passing rate If done properly, PBL is NOT excessively resource-demanding.,醫學教育研
25、究文獻顯示:,醫,醫?,P2,效成,教案的撰寫及規劃 Problem-design,TUTOR訓練及提升 Tutor training,資源的需求及分配 Resource Distribution,學生的錄取及評量 - Assessment,如何協導學習過程 - Counselling,如何引入実施PBL - Implementation,以問題為導向的醫學教育:基本架構 The basic elements of PBL,PBL的理念及認同 - Conceptualization,因此, PBL 不是一個授課方法, 而是一種學習方式. 更是一種理念: 改善學習態度的理念, 豎起良好學術風氣的
26、理念.,The PBL mask,PBL,Tradition 傳統思維,認知,Your thinking is steered by your past experience (tradition),傳統歷史包袱,Deeply rooted misconception,Students with high examination marks are better students and are suited for medical career.,University professors are more knowledgeable and are better teachers.,Old
27、er doctors are clinically more experienced and therefore make less medical errors.,錯誤的觀念,領導,Up, up and up !,2007-01-20,信念,前瞻未來,4C,Competence稱職勝任、 教育能力化。,Constructivism興創建構、教育整合化,Context學以致用、 教育情境化,Compassion仁心仁術、教育人性化,Foresee (4C) Our Future,PBL核心價值,前瞻途徑,4C,Communi- cative 會溝通,Constructive敢創新,Confid
28、ent 信心強,Cognitive 認知廣,Foresee (4C) Our Approaches,力行,Center for Faculty Development,Leadership Development,政行,CDF provides teachers with a conducive forum for skill development in enhancing academic proficiency.,CDF is a cross-University service unit aiming to place our University mission into persp
29、ectives for academic excellence.,Educational Development,成效,Outcome studies show that:,PBL makes learning more satisfactory and fun for students and teachers. PBL students use more resources and study for a longer period. PBL students have a longer retention time for knowledge recall. PBL students d
30、emonstrate more characters as life-long learners in the workforce.,Outcome studies also show:,If properly done, PBL does NOT have a negative impact on teachers academic career. PBL dose NOT reduce/narrow the scope of the knowledge content acquired. Medical schools using PBL do NOT have reduced natio
31、nal examination passing rate. If done properly, PBL is NOT excessively demanding on resources.,Conclusions,變,Time and experience,Performance,Pre-childhood learning (encounter),Child-learning (attachment),Adult learning,Change,1. Shock,2. Denial 3. Resentment 4. Resistance,5. Acceptance,6. Struggle 7. Redirection,8. Integration,(liberation),(separation),Cameleon - Yi,
