作者：Teresa Liu
何教授的研究是以臺灣11所醫學院的高年級醫學生為研究對象，藉由一對一訪談的方式來瞭解他們對於醫院評鑑的觀察與感想。學生注意到醫院在評鑑前及評鑑期間有一些正面的改變，例如加強打理門面讓醫院頓時煥然一新；高層較願意回應員工及學生的意見並做出改善；主管不斷提醒要遵循臨床指引，因而更重視病人安全與病人權益等。
然而，評鑑所帶來的負面影響遠多於正面影響，而且醫療人員、病人及學生都會受到影響。學生觀察到醫療人員必須準備大量繁瑣的文件資料，讓原本已經工作過量、壓力過大的他們更加疲憊；為了符合評鑑標準，主管對於細節會特別要求，讓他們無法依照平常的習慣做事。而過多的文書工作意味著照顧病人的時間被剝奪；學生也發現醫院關閉了部分門診、減少住院病人人數與手術次數，以符合評鑑標準，並且讓醫療人員有時間準備評鑑。
學生的受教權也受到影響，在評鑑前及評鑑期間，師長們較沒時間指導學生，原先排定的講演課或討論會常被取消；學生必須浪費時間填寫學習日誌或其他記錄，以符合評鑑要求；為了熟悉在與評鑑委員面談時該如何應答，他們必須進行模擬演練，參考評鑑教戰手冊的標準答案來回答；他們有時甚至被拖下水，幫忙在病歷記錄上補蓋章，或者「整理」病歷資料以符合格式要求。
學生認為醫院評鑑就像在大費周章、勞師動眾地演出一齣投合評鑑委員喜好的戲劇，但無法看出醫院的真實情況，而且許多因應評鑑所做的改變只是暫時性的，評鑑過後就不再持續實施。然而即使質疑、不滿，大家還是敢怒不敢言，乖乖照著上級指示去做，更別提向評鑑委員報料，畢竟評鑑結果攸關醫院的名聲與經費，而且不小心說錯話可能會被秋後算帳。
醫院評鑑原本是要提升醫療品質，但從何教授的研究我們看到的卻是「以通過評鑑為優先」的表面工作，而非實際改善病人所接受的醫療照護，甚至為了符合評鑑要求而做出違反專業誠信的行為。當醫學教育強調專業素養的發展，重視誠實、正直，而臨床現場卻給予相反的教育，這對於未來的醫師會造成什麼樣的影響呢？
文章出處：
http://vip.flysheet.com.tw:8080/mednews/061/item/382-jn-061.html
原文出處：
Effects of hospital accreditation on medical students: a national qualitative study in Taiwan. Ho MJ, Chang HH, Chiu YT, Norris JL. Acad Med. 2014 Nov;89(11):1533-9.
相關新聞：護士荒醫院評鑑是禍根
從根腐爛的制度，必須從根救起，監院主持正義，刻不容緩！
=======
延伸閱讀
=======
Effects of hospital accreditation on medical students: a national qualitative study in Taiwan.
PURPOSE:
Hospital accreditation has become a global trend for improving the quality of health care services. In Taiwan, nearly all hospitals are accredited. However, there is a paucity of literature on the effects of hospital accreditation on medical students and the universal applicability of hospital accreditation as developed in the West. The purpose of this study was to investigate the effects of hospital accreditation on medical students in Taiwan.
METHOD:
From 2010 to 2012, the authors conducted semistructured interviews with 34 senior, clinical year students at 11 different medical schools in Taiwan. Following a grounded theory approach, the authors transcribed and analyzed the transcripts concurrently with data collection in order to identify emergent themes.
RESULTS:
Aside from the intended positive effects of hospital accreditation, this study revealed several unintended impacts on medical students, including decreased clinical learning opportunities, increased trivial workload, and violation of professional integrity. Taiwanese students expressed doubt and frustration concerning the value of hospital accreditation and reflected on the cultural and systemic context in which accreditation takes place. Their commentary addressed the challenges associated with the globalization of hospital accreditation processes.
CONCLUSIONS:
This study suggests that, beyond the improvement of patient safety and quality assurance, medical educators must recognize the unintended negative effects of hospital accreditation on medical education and take into account differences in culture and health care systems amid the globalization of medicine.
PMID: 25250745
Effects of hospital accreditation on medical students: a national qualitative study in Taiwan. Ho MJ, Chang HH, Chiu YT, Norris JL. Acad Med. 2014 Nov;89(11):1533-9.
