- 期刊
臨床技能實作與評量於心理職能治療實習學生之應用
Application of Direct Observation of Procedural Skills (DOPS) in Occupational Therapy Internship in Mental Health
摘要
目的：職能治療臨床教學環境雖沿用醫學教育之客觀臨床教學評量，但仍缺乏文獻具體了解其於職能治療教學成效適用性的研究。本研究選用臨床技能實作與評量(Direct Observation of Procedural Skills, DOPS)工具檢視實習學生執行職能治療評量能力，研究問題包含：實習學生在(1)不同職能評量的DOPS表現？(2)第三次DOPS分數是否符合實習學生實際水準？(3)DOPS項目11（執行臨床技能之整體表現）是否可預測實習學生的成績表現，並反映教師對實習學生的學習滿意度？方法：本研究採回溯性分析，納入2011年7月至2015年10月期間，於南部某醫學中心精神部心理疾患職能治療實習之50位實習學生，採計其施予三項職能治療評量（普渡手功能測驗、褚氏注意力測驗、艾倫認知測驗）的DOPS分數。其中有三次完整DOPS評估資料者，才納入分析。結果：本研究共取得40名(80%)實習學生同意，回溯整理37名具完整DOPS分數者的資料，並進行統計分析。相依樣本單因子變異數分析結果顯示：實習學生在執行三種職能治療評量時，除了艾倫認知功能測驗項目三之外，其餘項目在DOPS皆有顯著進步。若以「第三次之表現是否符合實習學生水準？（達4級分）」檢視結果，評估普渡手功能測驗時之技能表現，約有59.5%至81.1%達4級分，褚氏注意力測驗約有64.9%至83.8%，艾倫認知測驗約有51.4%至75.7%。進一步分析了第三次「DOPS項目11」表現分別與「評估技巧期中成績」、「教師DOPS滿意度」之相關性，結果顯示僅與「評估技巧期中成績」達顯著中度相關(r = .48～.59, p ＜ .001)。結論：DOPS教學工具用於評量職能治療臨床實習效果具潛在的實用度，可用以監測實習學生在給予個案職能治療評估時，不同面向表現的變化，如：在指導語的給予、測驗物品的操作、臨場的應變上的進步狀況。本研究初步顯示DOPS能反映實習學生在職能治療評估操作上的進步；在實習完成後的操作表現，及格率約五成到八成；標準化的DOPS教學評量工具與部分傳統式評量的分數達中度相關。本研究對DOPS作為臨床實習教學評量提供初步證據，後續研究可進一步釐清其效度。
並列摘要
Objective: The standardized clinical teaching examination currently used in occupational therapy (OT) fieldwork was developed based on medical education. Literature specifically examining its applicability in assessing teaching effectiveness in OT fieldwork is scarce. This study examined the use of Direct Observation of Procedural Skills (DOPS) in OT clinical fieldwork, and aimed to: (1) describe students' performance in different occupational evaluations based on DOPS; (2) examine whether students' performance on DOPS meets the requirements of internships; and (3) assess whether the score on item 11 of DOPS correlates with students' conventional grades and their supervisor's satisfaction level. Methods: This was a retrospective study. Data were collected at a medical center in southern Taiwan from July 2011 to October 2015. Students of OT during a psychiatric internship were evaluated based on DOPS while conducting three occupational therapy evaluations: Purdue Pegboard Dexterity Test, Chu's Attention Test, and Allen Cognitive Level Test. Only students with pre-training, mid-term and post-training DOPS scores were included in the analysis. Statistical analyses included descriptive statistics, correlation analysis, and ANOVA. Results: Forty students (80% of all students) agreed to participate in the study; 37 students with complete DOPS scores were analyzed. Scores of majority items in DOPS improved after training, more than half of the students (51.4-83.8%) achieving the minimum requirement score (≥ 4) after training. The score of item 11 of DOPS was significantly correlated with the students' mid-term grades for skills assessment (r = .48 ~ .59, p ＜ .001). Scores of item 11 post-internship were significantly higher when conducting the Purdue test and Chu's Attention Test as compared with the scores when conducting the Allen Cognitive Level Test. Conclusions: The findings indicated that DOPS has the potential to be a practical tool for use in OT fieldwork education assessment. DOPS could be used to monitor students' progress in the administration of OT evaluations. Fifty to eighty percent of the students achieved the minimum DOPS standard upon finishing their internship. Standardized DOPS scores were significantly correlated with the conventional mid-term grades awarded by the supervisors. The value of DOPS may vary depending on the type of clinical evaluation. Our findings may inform the appropriate use of DOPS in OT fieldwork evaluations. Further research is needed to verify the utility of DOPS in assessments for allied health interns.