OSCE之測驗結果分析：成功大學醫學院經驗

Analysis of OSCE Results: Experience in National Cheng Kung University Medical College

蔡淳娟(Tsuen-Chiuan Tsai) ； 林其和(Chyi-Her Lin) ； 陳琮琳(Chung-Lin Chen) ； 趙可式(Co-Chi Chao) ； 葉宗烈(Taung-Lieh Yeh) ； 蔡景仁(Jing-Jane Tsai) ； 張伊凡(Yin-Fan Chang)

《Journal of Medical Education》 10卷4期 (2006/12) Pp. 313-323

https://doi.org/10.6145/jme.200612_10(4).0007

摘要

醫師的臨床技能需要被確實教導與評量，OSCE(Objective Structured Clinical Examination)是評量臨床技能的重要工具之一，近年來更成為美加與日本醫師執照考試的一部份。本研究目的為報告成大醫學院施行OSCE的早期成效，並示範如何使用心理評量分析，作為給學生回饋、改善課程與未來OSCE測驗品質之依據。本文收集2003至2005年間，在成大醫學院對醫六學生進行OSCE的相關資料，加以整理分析。結果：近三年間醫六OSCE各進行了8,15,8站，其中使用標準化病人站數有5,7,5站，其中四個共通站並沒有造成試題的安全性問題，但學生在各站的表現及考官的給分則差異頗大，以心理測量分析2005年73位考生OSCE分數顯示，此測驗之內部信度為0.62，其中三站乃測量不同面向，最後歸類為三個測量面向後，各面向內部信度分別為0.92, 0.81, 0.77，factor 1稱為一般性臨床技術，factor 2稱為深入性臨床技術，而factor 3則代表一種「操作型技術」(psychomotor skill)特質，學生的操作型技術表現不佳，以邊緣群族法判定及格標準時，有6.8%考生不及格。factor 1,2被發現各有一瑕疵子題需刪除或修改，兩站考官有子題與整體總評差異的問題。結論：研究結果顯示需加強考官訓練，改善評分表設計，提供充裕評分時間，及增加考官人數，以提高測驗品質，測驗後之成績分析對考官與考生之回饋以及改善課程極具貢獻。

關鍵字

OSCE ； 臨床技術 ； 因素分析 ； 心理評量 ； 評量

並列摘要

Without a doubt, to ensure physicians' competency, clinical skills should be taught and assessed accordingly. OSCE (Objective Structured Clinical Examination) has been widely recognized as an important tool for assessing clinical skills, which was lately becoming a part of Licensure examination in North America and Japan. This study is to report the implementation of OSCE in National Cheng Kung University Medical College from 2003 to 2005, and to demonstrate the use of psychometric analysis for student/faculty feedback and program improvement. 5HVXOW There were 8, 15, and 8 stations in the three-year OSCE, with the use of standardized patients in 5, 7, 5 stations out of them. The four common stations did not cause the problems of test security. Students' performance varied significantly across stations, and scores were different among raters on the multi-rater stations. The Cronbach's ɑ of OSCE scores from 73 students in 2005 was 0.62. The factor analysis revealed three factors: general clinical skills, delicate clinical skills and psychomotor skills, with the internal consistency of 0.92, 0.81, and 0.77, respectively. 6.8% of students were considered unsatisfactory by the standard-setting of ”borderline method”. Two items were deemed faulty, &RQFOXVLRQ To improve the quality of OSCE, it is suggested to promote effective training for raters, refine rating sheets, and increase rater size. The analysis of OSCE results is important to provide feedback for raters and students, as well as for curricular improvement.

並列關鍵字

OSCE ； clinical skills ； factor analysis ； psychometric analysis ； assessment

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