目標：
本研究目的在瞭解實習醫學生參與教學門診學習情況，調查實習醫學生教學門診實際學習上之需求及態度，並探討醫學生對接受教學門診後之學習成效，結合所需具備之六大核心能力的原則，探究學生教學門診學習情形之態度對於核心臨床技能提昇之助益程度的影響因素。
方法：
本研究為橫斷性研究，以南部某家醫學中心97學年度之實習醫學生為研究對象，研究設計以調查研究為主，並以結構式問卷進行，共發放78份問卷，回收67份。利用SPSS 12.0 for Windows 套裝軟體鍵入與處理。分析方法涵蓋1）描述性統計：分析實習醫學生教學門診學習情形、對於教學門診實施的意見及滿意程度。2）使用t檢定、變異數分析檢定影響實習醫學生在臨床能力提昇助益程度（六大核心能力具備之程度）的因素。3) 應用因素分析歸納出臨床能力之類型。4） 以迴歸分析，探討分析影響臨床能力提昇助益之相關因素。
結果：
本研究結果顯示醫學生每月平均參加1-2次最多有47人（70.1％），學員亦認為實施次數為一個月2次是適當的；醫學生認為教學門診3位病患最理想，大部分醫學生教學門診遇到3位病患的有36人（53.7％）最多；醫學生最常遇到的教學方式以學生先診療病患、再由老師指導學生佔有52人（77.6％）居多。
並經由因素分析發現六大核心能力應用於教學門診，結果將分類為三大能力，分別為基本醫療專業能力、進階醫療診斷技能、醫療專業應用知識。同時結果也顯示醫學生於教學門診訓練後，認為基本醫療專業能力的助益程度最高，其次為進階醫療診斷技能及醫療專業應用知識。研究亦發現醫學生在各項臨床能力之助益程度以「病史詢問」最高，其次為「理學及專科檢查」及「臨床診斷能力」，分數最低者為「行政作業流程之處理」，助益程度較高之三項能力，皆符合本研究分析臨床能力結果之「基本醫療專業能力」，可發現醫學生對於教學門診的臨床能力仍以追求基本醫療專業能力為主，較符合門診具備直接診療之特性。
結論：
本研究結果發現提昇學生整體臨床技能，影響助益程度最大的因素為「參與次數」、「指導師資」滿意度兩個因素，故需加強教學門診對學生臨床能力提昇程度，若能衡量被指導者參與次數之需求，有效地安排臨床業務及臨床教學時程，將可使教學門診制度更為完善；指導師資的教學熱忱、表達能力、教學態度、教學能力等個人特質皆會影響教學門診實施之成效。建議可加強培養指導者的教學能力，建議可定期舉辦各類教學課程之講習、研討、個案報告等繼續教育，培養有熱忱及具備教學技巧的指導者，以茲整體提昇教學門診之成效。

Objectives：The purposes of this study were to understand the circumstance of the learner about ambulatory care education and to realize the demand and attitudes of learning from the medical students, meanwhile to explore the effectiveness after receiving this education. Besides, this study is also combined with the six core competencies as principles to find out the attitudes of the education from the medical students and the factors of upgrading their clinical skills.
Methods：This cross-sectional study employed quantitative method to conduct the research, and this population included medical students from a medical canter of the southern of Taiwan. Structured questionnaires were conducted to medical students, a total of 78 uestionnaires were distributed with 67 questionnaires being returned.The data is analyzed by SPSS 12.0 and used descriptive statistics, factor analysis, t-test, and ANOVA, correlation analysis, and multiple regression analysis.
Results：The major findings were as following：
The results of this study show that most of the time, the medical students participated 1 to 2 times per month, and they also considered the implementation of 2 times one month is appropriate.The medical students also thought that the most ideal number of patient are three, and the result also showed that there were 36（53％） persons encountered three patients. Besides, the method which the students met was the medical student conducted diagnosis the patients first, and the teacher taught the students then. And there were 52（77.6％） persons encountered this situation.
The study found that the six core competences applied to the ambulatory care education will be classified into three abilities were” basic medical
expertise”、”advanced medical diagnostic skills”and”medical knowledge of professional application”. And the result also showed that after ambulatory care training, the basic medical expertise benefited best to the students, and then was the advanced medical diagnosis and medical knowledge of professional application.The study found that the best benefits of clinical competence of medical students was "history taking" followed by "physical and special inspection" and "clinical diagnostic ability", the lowest score was "the administrative processes". And these three abilities were in compliance with the results of clinical ability from this study which pointed to the “basic medical expertise”. It can be found that the goal of the ambulatory care education for the medical student was aimed to the basic medical ability, this result of the research was matched with the direct and discontinuous properties of the outpatient clinic.
Conclusion：The study found that the most beneficial factors which could enhance the students the overall clinical skills are the frequency of participating ambulatory care education and the attitudes and enthusiasm of the teaching physicians. If we could measure the demand of involving in the ambulatory care education from the trainee, we could effectively distinguish from the clinical operations and clinical teaching schedule, in this way, it will make the system of ambulatory care education perfect.
In addition, the guidance of teachers such as the enthusiasm、communication skills、friendly attitude、teaching ability and the other personal characteristics will affect the effectiveness of the implementation of ambulatory care education. It was recommended to strengthen the capacity of training instructors about teaching, the manager could regularly organize various workshops, seminars, case report, continuous education to train the enthusiastic teaching physician and made them have the teaching skills of instructors in order to enhance the effectiveness of the ambulatory care education.

中文摘要 Ⅱ
Abstract IV
致謝 VI
目錄 VII
圖目錄 IX
第一章 緒論 1
第一節 研究動機與重要性 1
第二節 研究目的 3
第二章 文獻探討 4
第一章 教學門診的起源及定義 4
第二節 醫學教育目標與趨勢 7
第三節 教學門診評估情形及相關研究結果 10
第四節 結論 19
第三章 研究方法 21
第一節 研究架構與設計 21
第二節 研究樣本 24
第三節 研究工具與變項 24
第四章 研究結果 29
第一節 描述性統計分析結果 29
第二節 因素分析 36
第三節 推論性統計分析結果 40
第五章 結論與建議 49
第一節 研究結果討論 49
第二節 研究貢獻 53
第三節 研究限制與後續研究建議 54
參考文獻 55
附錄 教學門診問卷調查表【被指導學員】 59

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