研究背景：本研究旨在探討新冠肺炎期間，醫學教育的變化對臺灣畢業後一般訓練(Post-Graduate Year)醫師和健康照護臨床學生(Allied health students)臨床信心的影響，同時關注臺灣新冠肺炎社會管制措施對醫學教育的潛在影響，包括臨床培訓模式是否改變、直接護理/接觸病人的經驗，以及新冠肺炎前後的學習壓力變化。同時，本研究探討這三方面對參與者臨床信心的影響，以及心理健康是否在其中起到中介效應。

研究方法：本研究採用橫斷性的線上問卷調查臺灣的 PGY 醫師和健康照護臨床學生。研究者透過建構結構化網路問卷，包括人口學特徵、COVID-19大流行對醫學生的影響問卷(Effects of the COVID-19 pandemic on medical students)、臨床信心量表以及中文版憂鬱焦慮壓力量表(The Depression, Anxiety and Stress Scale - 21 Items)。資料分析採用SPSS 17.0，運用了描述性統計、獨立樣本T檢定、皮爾森卡方檢定、皮爾森相關、中介分析和多元階層迴歸模型。

研究結果：本研究自2022年9月起開始收案。截至2023年4月，共有1,037名參與者填寫問卷，最終以540位有效資料納入分析。參與者以女性居多(64.4%)，平均年齡為24.48歲(SD= 3.59)，且參與者多為健康照護臨床學生(62.8%)。結果顯示，臺灣新冠肺炎大流行前後，臨床培訓模式無顯著變化(p= 0.519)，且不會影響參與者的臨床信心(p= 0.283)。臨床培訓模式的改變與參與者的臨床信心(p= 0.070)和心理健康狀態(p= 0.575)無關；直接照顧/接觸病人的經驗可以提升參與者的臨床信心(β= -1.92; p< 0.001)，但並非中介效應所導致；新冠肺炎流行前後學習壓力上升會惡化參與者的臨床信心(β= 0.51; p= 0.002)，是因心理健康的完全中介所致(BootLLCI= 0.08, BootULCI= 0.34)。

結論：本研究為瞭解臺灣 PGY 醫師和健康照護臨床學生在新冠肺炎期間所面臨的挑戰提供了寶貴的見解。主管機關於新冠肺炎流行之前所建立的應對機制以及教學單位所實施的彈性教學方式使參與者的臨床信心得以穩定，但也強調需要直接照護/接觸病患的臨床經驗在醫學教育中至關重要。研究結果還強調了解參與者的學習壓力調適和心理健康情況的重要性，以便在危機時期提供即時援助。 然而，本研究也承認其侷限性，包括需要進一步調查疾病流行嚴重程度的地區差異和各健康照護科系所遭遇的變化。

Background: This study aimed to investigate the impact of changes in medical education on the clinical confidence of Post-Graduate Year (PGY) doctors and allied health students in Taiwan during COVID-19 pandemic, and to focus on the potential effects of the infection control policies measures implemented during the pandemic, including changes in clinical training modes, direct patient care experiences, and difference in learning stress before and after the COVID-19 pandemic. The study explored the influence of these aspects on participants' clinical confidence and examines whether mental health serves as a mediating factor.

Methods: A cross-sectional online survey was conducted among PGY doctors and allied health students in Taiwan. The researcher constructed a structured online questionnaire, covering demographic characteristics, the Effects of the COVID-19 pandemic on medical students, a clinical confidence scale, and the Chinese version of the Depression, Anxiety and Stress Scale - 21 Items. Data analysis employed SPSS 17.0 and included descriptive statistics, independent samples t-tests, Pearson chi-square tests, Pearson correlations, mediation analysis, and multiple hierarchical regression models.

Results: The study commenced data collection in September 2022, and by April 2023, 1,037 participants completed the survey, with 540 valid responses included in the final analysis. Most participants were female (64.4%), the average age was 24.48 years (SD = 3.59), and most participants were allied health students (62.8%). Results indicated no significant changes in clinical training modes before and after the COVID-19 pandemic in Taiwan (p = 0.732), and it did not impact participants' clinical confidence (p = 0.215). Changes in clinical training modes were unrelated to participants' clinical confidence (p = 0.219) and mental health status (p = 0.607). Direct patient care/contact experience significantly enhanced participants’ clinical confidence (β = -1.92; p < 0.001), but this was not due to a mediating effect. The increase in learning stress before and after the COVID-19 pandemic worsened participants’ clinical confidence (β = 0.51; p = 0.002), which was complete mediated by mental health (BootLLCI = 0.08, BootULCI = 0.34).

Conclusion: This study provided valuable insights into the challenges faced by PGY doctors and allied health students in Taiwan during the COVID-19 pandemic. The established mechanisms by authorities before the pandemic and the implementation of flexible teaching methods by educational institutions contributed to the stability of participants' clinical confidence. However, the study emphasized the crucial importance of direct care/patient contact experiences in medical education. The results underscore the significance of understanding participants' adaptations to learning stress and mental health conditions for providing timely assistance during crises. Nevertheless, the study acknowledges its limitations, including the need for further investigation into regional disparities in the severity of the pandemic and variations encountered by different health care departments.

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