牙醫醫療院所實施牙醫PGY制度之研究

Abstract

2010年臺灣開始實施兩年期牙醫師畢業後一般醫學訓練計畫（Post Graduate Year Training Program for Dentists，簡稱PGYD）後，牙醫醫療院所便開始投入訓練計畫。本研究的目的，在於了解2010年~2018年牙醫醫療院所及受訓牙醫師參與PGYD的情形。採用次級資料研究法蒐集歷年訓練計畫名單，並以方便取樣方式，進行問卷調查，蒐集初級資料與分析。本研究蒐集完整PGYD訓練計畫名單，顯示訓練計畫數穩定成長，總訓練計畫數由119件穩定成長到195件，醫院的訓練計畫數由68件增加到75件，而診所的訓練計畫數由51件增加到120件。醫院及診所皆以提出單一訓練計畫為主。醫院以單一訓練機構的類型成長最多，而診所則是以聯合訓練群組中合作訓練機構的類型呈現大幅成長。訓練機構多集中在北部地區，以勞倫茲曲線、吉尼係數分析，顯示主要訓練機構登記執業牙醫師人數分布不平均程度最為嚴重。本研究自全臺灣蒐集有效問卷共283份，有165位研究對象是在北部地區訓練，在醫院與診所的比率約為6：4。在醫院的研究對象特質，以完訓時年齡在20-29歲、在醫學中心訓練及單一醫院的訓練計畫為主；而在診所的研究對象特質，以完訓時年齡在20-29歲、在連鎖型診所訓練及聯合訓練群組中診所為主要訓練機構訓練的訓練計畫為主。對於訓練成效的自我評估，以在北部地區及獨立型診所訓練的研究對象明顯較佳。對於訓練情境的評估，以在單一診所及聯合訓練群組中診所為主要訓練機構訓練的研究對象明顯較佳。在診所訓練通常能有較多的看診人數，從實際的治療演練中獲得較佳的訓練成效。整體而言，PGYD制度實施以來，訓練計畫的類型是以單一訓練計畫為主，訓練機構的類型，醫院偏向單一訓練機構的類型，而診所多為單一訓練機構及合作訓練機構。訓練資源仍然集中在北部都會區，訓練機構牙醫師人數分布不平均的因素也仍然存在。診所有較佳的PGY訓練情境，也有能力提供足夠的訓練資源而達成主管機關要求的訓練成效。在醫院訓練的優點是較易接觸到偏困難的病例，而促進受訓牙醫師臨床專業能力的提升及思考朝牙醫專科領域發展。在診所訓練的優點則是同事間互動密切、有接觸較多患者滿足訓練需求及良好醫患關係的提升。不論是在醫院或診所訓練，受訓牙醫師日後服務的場所仍以診所為主。而診所有地理分布廣及訓練成效、情境較佳的優點，未來PGYD政策宜鼓勵診所參與度的提升。Background/purpose: Taiwan implemented the two-year Post Graduate Year Training Program for Dentists (PGYD). Hospitals with dental department and clinics have participated in PGYD since 2010. This research aims to understand the situation of dental institutions and dental trainees in PGYD from 2010 to 2018. Materials and Methods: The secondary data analysis and questionnaire were adopted to obtain the annual program lists through website and collected the primary data of the research subjects by convenience sampling. Results: The results showed the number of program has increased steadily since 2010. The total number of the training program increased from 119 to 195. Among them, the number of hospitals increased from 68 to 75, the number of clinics increased from 51 to 120. Hospitals and dental clinics both mainly presented clinical training single system. Hospitals have grown mostly in single system, while clinics as collaborating facilities in the clinical training facilities-group system have grown drastically. Geographically, the training facilities carried out a concentrated number in the northern Taiwan. The analysis of the Lorenz curve and the Gini coefficient, which showed the number of dentists belong to the major training facilities with a significantly greater imbalance in distribution. In this study, 283 valid questionnaires collected from Taiwan, and 165 research subjects were trained in the northern. The ratio of hospitals to clinics was about 6:4. The characteristics of the research subjects in the hospital often were 20-29 years old, and in the medical centers and single hospitals of the clinical training single systems. The characteristics of the subjects in the clinic often were 20-29 years old, and in the major training institutions of the clinical training facilities-group systems. By assessment of training, both the research subjects trained in the northern Taiwan, in the independent clinics; or in clinics in the single or facilities-group system were significantly better. Training in the clinics often has more patients for dental performance and has more training effectiveness. Conclusions: Overall, during 2010 to 2018, single system is the main form and has evident growth. Most hospitals prefer the single system to join PGYD, especially the dental medical school hospital. The number of dental clinics as single or collaborating facilities both obviously grows. Geographically, the number of facilities has evident increase in the northern Taiwan, indicating the majority of training resources gathered in urban areas. The imbalance distribution mentioned still exists. The clinic has a better PGY training situation and the ability to provide sufficient training resources to achieve the training targets required by the competent authority. The advantages of training in hospitals are easier to access difficult cases and promote the clinical professional ability, the guidance of sufficient professional knowledge and the improvement of clinical professional ability of trained dentists. It also promotes the development of dental specialists in the field of dentistry. The advantage of training in the clinic is that the interaction between colleagues is more closely, the patients with more contacts meet the training needs and the relationship between dentists and patients is better. Whether it is training in a hospital or clinic, the places where the dental trainees serve in the future should mainly be clinics. Since clinics have the advantages of wide geographical distribution and higher training effectiveness. The PGYD policy should encourage the participation of clinics in the future.