Medical education has long been a primary goal at Taichung Veterans General Hospital. The Department of Medical Education is the heart of the hospital's comprehensive organizational structure for teaching, which includes the Division of Faculty Development, Division of Clinical Training, Section of Medical Education, and Section of Medical Library. There is also an integrated teaching building, which houses a national-level advanced OSCE examination hall, the Clinical Competences Center, the Minimally Invasive Surgical Center, among other facilities, providing various medical teaching and training for all levels of medical personnel.
In line with our philosophy of patient-centered care and interdisciplinary learner-centered teaching, we are committed to gradually expanding medical education to all levels of physicians and medical personnel, and to strengthening evidence-based medicine education. Upgrading patient safety and implementing holistic care are our major goals in medical education.
At Taichung General Veterans Hospital, we have constantly emphasized the importance of medical teaching over the years. Our successive superintendents and our entire staff have invested considerable resources in the continuous promotion of high quality medical education. In addition to providing a wide range of incentives to create a learning environment that befits a top-tier teaching hospital, we have raised funds from supportive businessmen to set up many major simulation teaching facilities. Our reputation for excellence in teaching performance has been recognized by various sectors, and we are a benchmark hospital for studies by national and international teaching-related experts and scholars. Furthermore, we are a key teacher training center and teaching hospital for physicians and medical personnel in Taiwan.
Our high-quality teaching has been based on "learner-centered" principles and the implementation of "patient-centered" healthcare training. Moreover, interdisciplinary teamwork education is applied to improve the quality of healthcare and to achieve the goal of "holistic health care." Since 2010, "excellent teaching quality" has been included as one of the six Balanced Score Card strategy themes using BSC management tools to track effectiveness. The essential principles of "lean thinking" are applied to the integration of teaching information to improve teaching performance.
We are the largest and most comprehensive education and training center for physicians and medical personnel in central Taiwan. We teach and train both medical students and medical personnel in various fields nationwide. We are also one of the few hospitals in Taiwan that can provide full training for 26 specialties and 13 major categories of medical personnel. The annual average pass rate of trainee physicians is close to 100 percent.
Our Hospital continues to organize the General Medicine Teachers Training Camp, Essential Program, to train instructors from this and other hospitals in holistic medical care teaching skills. The overall satisfaction rate for our hospital's training methods and teaching modules exceeds 90%.
We have collaborated with the Clinical Ethics and Law Center to develop ethics training courses for tutors. In addition, we cooperate with the Center of Evidence-Based Medicine (EBM) to oversee qualification of EBM tutors. The tutors are certified and graded according to their ability to instruct EBM. Thus, hospital staff from all fields can fully implement evidence-based medicine in their clinical work.
Relevant study programs are organized to enhance teaching skills based on a step-by-step approach, adopting a variety of interactive teaching methods. Program content includes basic skills and advanced training such as curriculum design, evaluation skills, teaching skills, teaching material production, and so on.
We conduct faculty development courses on interprofessional and holistic care. Team work training is arranged for patient-centered holistic care. The faculties can learn through the use of training exercises, including group discussions and role play.
The World Café model is used annually. Attendees discuss relevant issues in an open and relaxed atmosphere in order to enhance clinical teaching skills and promote exchanges of experience.
To expand the range of medical education, we publish the Taichung Veterans General Hospital Medical Education Journal to share trends in medical education. In 2015, it transited to a peer review journal, providing medical personnel both in the hospital and nationwide a place to publish research papers on medical education.
A teaching material support group provides services for the production of teaching materials. The group produces teaching films, posters, and printing services based on teaching needs.
The Taichung Veterans General E-learning network was established for clinical teachers to provide learners with another learning method to preview courses in advance and review them afterwards.
Our teaching methods emphasize a learner-centered approach. The training of general physicians, for example, includes the following features:
Each student has an exclusive clinical teacher. The teacher-student ratio is in accordance with the provisions of the governing authority, and "protected learning time" is arranged. All kinds of clinical care instructions are also carried out. Moreover, in terms of life counselling, all trainees are assigned an exclusive mentor to provide timely counselling for life and learning issues.
The General Internal Medicine Training and Demonstration Center was funded with the medical education sponsorship of the Ministry of Health and Welfare. The training provides trainees with "patient-centered" holistic care skills and enables them to learn the ethos of a medical team. By training in internal medicine, the trainees are instilled with the holistic health care concepts of compassion and integrity; their knowledge and skills in general preliminary disease assessment and initial treatment are also enhanced.
The wards in the General Internal Medicine Training and Demonstration Center are set up with various pieces of equipment to assist in teaching, such as examination rooms (there are teaching mirrors for facial features, inspection stations, non-mydriatic auto fundus camera), and exclusive rehabilitation treatment rooms.
Based on the different levels of the trainees, including senior resident doctors, resident doctors (including PGY), interns (UGY), and senior medical students, we have developed different training manuals, training courses, and assessment methods under the principles of the six core competencies.
Curriculum planning is based on the development of the six core competencies. The courses include teaching clinic, bedside instruction, communication skills, physician teaching clinic, chest X-ray instruction, a magazine and journal reading group, various discussion groups, and others. Courses and practical exercises are arranged to provide instruction in laboratory technical operations, ophthalmoscope case guidance, abdominal ultrasound, and other clinical and technical guidance.
A range of teaching methods are employed based on the needs of course content, including didactic lectures, small group discussions, demonstration teaching, bedside teaching, implementing clinical practices, simulation training, minimally invasive surgical skills instruction and training in small classes, and OSCE simulation tests. Exclusive "protected learning time" is provided for medical interns; this teaching concept is also adopted at Harvard Medical School.
Lean thinking-orientated pre-employment training and basic and core courses are arranged, and a pre-round and primary care system has been implemented, simultaneously enhancing both learning and practical experience for interns. They can be involved in the care of patients under the complete guidance of a full medical team. They can also look after the patients' safety and develop the six medical practice abilities at the same time.
We set up the Taichung Veterans General Hospital E-learning network to allow learning without the constraints of time and space. Trainees can undertake training based on an integrated approach and with easy accessibility.
An E-learning course (E-Portfolio) records the trainees' learning process, including a Mini-clinical Evaluation Exercise (Mini-CEX), Direct Observation of Procedural Skills (DOPS), case-based discussion (CbD), 360 degree assessment, and other evaluation tools. This enables a comprehensive assessment of trainees' learning performance and gives them two-way evaluation feedback.
We make use of the E-Portfolio system to establish two-way communication among clinical teachers, tutors, and students. After the courses, teachers assess the trainees and teaching environment, and trainees assess teachers, and face-to-face discussion groups for trainees are held on a frequent basis. We also offer a 72-hour reply"medical forum" system.
Students at all levels (UGY, PGY, international exchange students, etc.) can express their opinions about their experience with the teaching provided at Taichung Veterans General Hospital and appropriate feedback is encouraged. Clinical teachers also convey their expectations to PGY trainees.
The Excellent Student Award is given to a number of Undergraduate Year (UGY) students and Postgraduate Year (PGY) trainees on graduation in recognition of their outstanding performance. A formal dinner is held at the end of the training so that the students can celebrate with their teachers.
ur hospital set up the first clinical training center in central Taiwan in July 2004. In November 2013, the center was transformed into the Division of Clinical Training, which is located on the 2nd and 3rd floor of the Education Building.
The second floor is a square structure which houses 6 classrooms for training clinical skills, a simulated ward, a simulated operating room, and a central control room. The OSCE national certification center is located on the third floor and has a rectangular floor pattern. There are 15 simulation consultation rooms in total, one audio-visual control center, and a central classroom. Based on the different needs of examination scenarios, there are different modes and scene configurations. Construction of the examination environment and the use of the video recording, video, broadcasting system settings in the central control room ensure that the examination is conducted smoothly.
Comprehensive simulation settings for teaching and assessment, including advanced simulators for human cardiovascular, urinary, respiratory, and the other major systems of 22 major categories and 250 groups, offer a variety of training modules for physicians, medical personnel and trainees in the hospital for learning and training purposes.
High-fidelity simulators include interactive wireless mannequins: iStan, METIman, SimBaby, SimJunior, computer-simulated patients, maternal delivery model and dental simulation equipment, sonography simulators, and so on. All divisions of medical departments can make use of curriculum designs and all categories of high-fidelity simulators to assist medical interns, general physicians, resident doctors, medical personnel, and dentists. Teamwork training, like critical patient transferral is conducted with simulators. In addition, highly advanced simulation training for emergency clinical case discussion and teamwork training, medical team placement for emergency situations and communication (ISBAR), normal labor processes, first-aid treatment and bleeding during labor, difficult labor processes, endodontics, and prosthodontics, are provided. These clinical training courses and real operation practices allow trainees and staff to learn how to deal with difficult cases in order to meet the targets of the teaching plans for different medical departments.
Another training feature is the Objective Structured Clinical Examination (OSCE) which has been implemented for personnel in all divisions, including interns, resident doctors, and all medical staff. We assess students' knowledge, attitude, and other clinical skills with standardized patient and simulation modes, including medical communication, physical examination, medical history, disease health education, and operation skills. Teachers can review their teaching effectiveness with the results of assessment. We also use questionnaires to obtain student feedback. In 2013, OSCE was widely applied as one of the national medical licensing examinations.
The Department of Surgery established the Minimally Invasive Surgical Center as a task force in 2005. In November 2013, the unit was transformed into a clinical teaching division, the Minimally Invasive Surgical Education and Training Center. The surgical theatre was set up with six surgical training operating tables. Each table has a complete laparoscopic set, anaesthesia, microscopes and other equipment, as well as a simulation training classroom: it is equipped with a minimally invasive surgical simulation training box as well as various surgical skills training equipment, offering physicians a self-learning opportunity and venue.
All kinds of surgical training courses are conducted, such as laparoscopic surgery training, laparoscopic training box training, microvascular suture, intestinal anastomosis training, chemo-port introduction, needle placement angle, bladder lavage, chest tube insertion practice, suprapubic catheter insertion exercise, a wound closure course, shoulder and hip arthroscopy surgery demonstration, minimally invasive spinal neurosurgery study, Ultra-Z Super Ultrasound Lipolysis, and ATLS training. The equipment is available to rent by other hospitals, and inter-hospital training collaborations are carried out frequently.
The main purposes of the Minimally Invasive Surgical Center are to train a well-prepared teaching faculty, to utilize the comprehensive hardware facilities to help trainees learn minimally invasive surgical techniques with the guidance of experts, to promote the basic surgical abilities of resident doctors, and to enhance the surgical abilities of all resident doctors, PGY, and UGY trainees in the Surgical Department.
The HPSN Chinese 2014 International Chinese Simulated Medical Education Seminars were organized by our center to allow domestic and international medical teams to acquire an in-depth understanding of the application and development of various simulation systems, and also to share their knowledge of medical simulation in the fields of nursing, integrative medicine, emergency medicine, and so on.
We are committed to continually improving teaching methods for traditional clinical skills training, strengthening clinical skills, reducing medical errors, and improving the quality of medical care and patient safety. By applying an integrated approach, we aim to provide medical trainees, physicians, and medical personnel from all fields with the clinical skills training, materials, and continuous education needed to achieve the highest possible standards of medical education.
The excellent standards in medical education that we have been able to achieve have been recognized by students and medical education authorities. We are proud of our accomplishments in medical education:
|◎||PGY optional recruitment has reached a full capacity rate of 100%.|
|◎||Trainees from our hospital have a pass rate of 100% for the Clinical Skills Assessment (OSCE); the average pass rate for the national medical licensing examination was 95% over the past three years.|
|◎||Our performance evaluation index received a credit of "Outstanding Performance" in the evaluation for Teaching Hospitals' Effective Use of Teaching Subsidies.|
|◎||The General Internal Medicine Training and Demonstration Center has been awarded the credit of "Outstanding Performance" several times after inspection by the Taiwanese Association of Medical Education.|
The Taiwanese Association of Medical Education arranged for newly established demonstration centers (Kaohsiung General Veterans Hospital, Kaohsiung Medical Hospital, Changhua Christian Hospital, and Taipei Hospital), accompanied by officers from the Ministry of Health and Welfare and the Taiwan Joint Commission on Hospital Accreditation, to observe the operation of the General Internal Medicine Training and Demonstration Center in our benchmark hospital. Officers from the Control Yuan Committee and Examination Yuan, as well as medical education experts from Taiwan and abroad have visited our hospital and exchanged teaching ideas. We have received a lot of positive feedback.
Due to our benchmark performance in general medical training, the Taiwan Joint Commission on Hospital Accreditation arranged for two medical education scholars, Dr. Andrew Long and Dr. Ian Curran from England’s The Foundation Program, to visit our General Internal Medicine Training and Demonstration Center and Clinical Competence Center. Both scholars spoke very highly of our resourceful teaching programs and the dedication of our clinical teachers.
Every year we attend the general medical education teaching film competition held by the Taiwan Association of Medical Education with encouraging results.
We firmly believe that by strengthening our rigorous medical education training based on comprehensive holistic healthcare we can help various medical personnel to acquire abilities in logical analysis and team spirit. We are committed to providing excellent quality medical care from a holistic perspective, and to reaching our goal of becoming a benchmark for teaching hospitals.