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題名：臨床教育環境量表中文精簡版信效度評估與應用
作者：黃靜宜
作者(外文)：HUANG,CHIN-YI
校院名稱：國立臺南大學
系所名稱：教育學系測驗統計碩博士班
指導教授：鄒慧英
學位類別：博士
出版日期：2017
主題關鍵詞：臨床教育環境量表；信度；效度；Postgraduate Hospital Educational Environment Measure (PHEEM);；reliability;；validity.
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臨床教育環境與學習者的學習表現及工作滿意度具有密切關係，透過具有良好信效度的臨床教育環境評估工具，可以改善臨床學習環境。本研究旨在驗證臨床教育環境量表中文精簡版信效度、瞭解實習醫師及住院醫師臨床教育環境滿意度，及臨床教育環境滿意度與壓力知覺、工作疲憊、學習表現之關聯性。
以住院醫師、畢業後一般醫學訓練 (Post-graduate Year, PGY) 醫師及實習醫師為研究對象，預試樣本共289位，正式樣本共428位。藉由結構方程式及Rasch 模式來檢驗量表之信、效度，皮爾森相關係數檢定臨床教育環境知覺與學習表現、壓力知覺、工作疲勞間之關聯性。
依據因素分析結果顯示，本工具可分臨床教育環境氛圍、臨床教師效能以及訓練與工作時數適當性等三個向度，且在結構方程模式及Rasch 模式均具有良好的模式-資料適配度，顯示本工具有良好的建構效度。信度證據方面，臨床教育環境氛圍、臨床教師效能以及訓練與工作時數適當性的受試者分隔信度0.80至0.90；另外，全量表Cronbach’s α係數為0.96，分量表Cronbach’s α係數為0.86~0.94，顯示本評估工具之信度大致良好。整體而言，臨床教育環境量表中文精簡版具良好的信度與效度。此外，學校附設醫學中心與非學校附設醫學中心的實習醫學生在臨床教育環境氛圍的滿意度高於區域醫院，向度二，學校附設醫學中心與區域醫院的實習醫學生在臨床教師教學效能的滿意度無顯著差異，二類醫學中心與區域醫院實習醫學生在訓練與工作時數適當性的滿意度亦無不同。男生和女生的臨床教育環境各向度滿意度沒有顯著的差異。內、外、婦、兒科住院醫師在臨床教育環境氛圍及訓練與工作時數適當性的滿意度顯著低於其他科的住院醫師。在臨床教育環境氛圍與訓練與工作時數適當性二個向度，PGY醫師的滿意度顯著低於實習醫學生，實習醫學生的滿意度又顯著低於住院醫師；在臨床教師效能向度，PGY醫師與實習醫學生的滿意度顯著低於住院醫師。研究結果和過去的文獻大致符合。實習醫學生及PGY醫師的臨床教育環境知覺與學習分數有低度正相關，其臨床教育環境滿意度與壓力、工作疲勞呈現中度負相關性。
Clinical education environment is positively related to learning performance and job satisfaction. A valid instrument is essential to evaluate the clinical education environment and improve it. This study aimed at examining the reliability and validity of the Chinese version of the short form Postgraduate Hospital Educational Environment Measure (PHEEM). The interns’ and residents’ satisfaction of clinical education environment were investigated in this study. The relationships between satisfaction of clinical education environment, perceived stress, job burnout, and learning performance were also examined.
The subjects of this study were residents, post-graduate year (PGY) residents, and interns. The pre-test was admisitered to 289 subjects and 428 subjects were collected in the formal test. Reliability and validity were examined by structural equation modeling (SEM) and Rasch model. The relationships between satisfaction of clinical education environment, perceived stress, job burnout, and learning performance were examined by Pearson's correlation coefficients.
Results showed that the short form PHEEM could be divided into three dimensions: climate of clinical education environment, effectiveness of clinical teacher, and appropriateness of training and working hours. SEM and Rasch model showed a good model-data fit, indicating good construct validity. The person separation reliabilities of the climate of clinical education environment, effectiveness of clinical teacher, and appropriateness of training and working hours ranged from 0.80 to 0.90. In addition, Cronbach’s α was 0.96 for the whole scale and 0.86-0.94 for the sub-scales. Both evidences showed that the reliability of short form PHEEM was pretty well. Overall, the Chinese version of the short form PHEEM had satisfactory reliability and validity.
Further tests showed that satisfactions on climate of clinical education environment of the interns from university-affiliated and non-university-affiliated medical centers were higher than those from regional hospitals. For the dimension of effectiveness of clinical teacher, the interns’ perception from university-affiliated medical centers and regional hospitals were no different. As for the third dimension, appropriateness of traning and working hours, the interns of the two kinds of medical centers and regional hospitals showed no significant difference too. Considering the gender effect, no difference was found on all three dimensions of the clinical education environment. Residents of internal medicine, surgery, obstetrics, and pediatrics divisions showed significantly lower satisfactions than those of other divisions on climate of clinical education environment and appropriateness of training and working hours. For dimensions of climate of clinical education environment and appropriateness of training and working hours, the satisfaction of PGYs were significantly lower than those of interns, while those of the residents were of the highest. For the dimension of effectiveness of clinical teacher, PGYs showed significantly lower satisfactions than residents. The results of this study were consistent to previous studies. Perceptions of clinical education environment and learning performance showed low positive correlations for interns and PGYs. Their satisfactions on clinical education environment showed medium negative correlations with stress and job burnout.
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