雙案例教學模式導入醫學倫理課程之成果: －以長期呼吸器倚賴病人照護為例

This qualitative research aims at explicating the theoretical framework and preliminary outcome of implementing duo-case method (i.e., experiential learning of a bedside case following with small group discussion on a classic dilemmatic case) among Year-4 medical students. Multi-perspective in-depth reflection and clinical deliberation are anticipated to be developed through observing, presenting, and discussing patients under mechanical ventilator use. Rest’s Defining Issues Test (DIT) was borrowed both for clinical scenario design and for group discussion. The learning objective of this course is to facilitate students’ ethical sensitivity. “Four-Topic Approach” proposed by Jonsen et al. was also introduced to students or collecting relevant ethical issues and fostering a structured, sound and justifiable ethical case analysis. Moreover, based on the structure of four topics, template analysis and content analysis were used to analyze students’ perspectives and feedbacks during and after the course. After data coding, 639 statements were identified and iteratively emerged into 42 main concepts locating within the four themes we have focused on. Our result shows that all of the 16 groups, which include 165 students in total, have explicated more than one argument in each theme to support or refuse to sign the DNR. Although disparity existed in between each group in terms of both quantity and quality of the rationales proposed, medical indication, patient preference, quality of life and contextual features have been all considered and addressed by each group. Further analysis on students’ reflective portfolio showed that all students have acknowledged family’s perspective on doctor’s clinical judgment and decision.