摘要
前言：隨著現今醫療科技的發展、資訊的進步、社會經濟的變遷與疾病趨漸複雜化，大眾對於醫療品質的重視與要求日益提升，醫學教育的方向除了傳統的醫療知識傳授，更著重在技能的訓練和態度的培養。OSCE（Objective Structured Clinical Examination）客觀結構式臨床測驗，是用來評量臨床技能的重要工具之ㄧ，因具有高信度、效度及可行性而被各國廣泛使用中。我國去年7月已將通過OSCE考試列為醫師國家考試第二階段應考資格，並積極規劃納入牙醫師國家考試中。 目的：探討牙醫學系OSCE考題各個面向的驗證及學生OSCE成績與各科臨床實習表現之相關性。 方法：本研究採縱貫性追蹤研究設計，研究對象為南部某醫學大學牙醫學系六年級學生共52名，收案期間為101年5月至102年5月，以OSCE客觀結構式臨床測驗為評量方式做為前後測，OSCE測驗皆各為三站，前測於學生進入臨床實習訓練前，實行OSCE測驗收集其總分後，學生進入常規之臨床實習部門，為期一年，取得各科臨床實習成績，於臨床實習結束前，再實行OSCE做為後測，並收集其總分。以SPSS 19.0版軟體進行分析，統計方法使用描述性統計、變異數分析、配對t檢定、信度分析、折半信度分析、難度分析、鑑別度分析、因素分析、相關係數分析、簡單線性迴歸、複迴歸分析。 結果：OSCE考題測驗內容之信度評估Cronbach Alpha值為0.60~0.75、折半信度Spearman-Brown係數值為0.17~0.84之間，於可接受範圍內，但部分題項需要做修改；在OSCE各題考題項目分析方面，以難度合併鑑別度分析之結果，Cronbach Alpha值可提高至0.63~0.76之間。各科臨床實習成績平均值為84.39~88.71分之間，前測與後測OSCE成績平均值分別為162.40、181.27分，而前測與後測OSCE成績差值的平均值為18.87分，標準差為39.64分(P<0.001)。前測OSCE成績與牙周病科(r=0.30、p=0.032)、家庭牙醫科(r=0.33、p=0.017)呈正相關。後測OSCE成績與保存科(r=0.36、p=0.009)、補綴科(r= 0.34、p= 0.015)與牙周病科(r= 0.27、p= 0.041)有正相關趨勢。 結論：學生經過為期一年的臨床實習訓練之後，其OSCE成績有明顯升高的趨勢。OSCE考題可運用難度合併鑑別度分析考題的內部一致性和穩定性，及可利用因素分析做為OSCE考題驗證的方法。臨床實習訓練後，可明顯增加單項技能操作的能力，但在醫病溝通及X光影像判讀方面則待加強，建議在未來實習訓練計畫內，需加強醫病溝通技巧及影像判斷的能力。
並列摘要
Background：With the development of modern medical technology, progress of information, social -economic change and disease becoming increasingly complex, the public's attention and demand to the quality of medical care is increasing. Methods of medical education are not only traditional medical knowledge transfer, and should be more focused on the development of skills training and attitudes.OSCE (Objective Structured Clinical Examination) is an important clinical skills assessment instrument. It has been widely used in various countries, because of its high reliability, validity and feasibility. In Taiwan, OSCE exam was added in the second stage of national physician examinations in July 2013, and prepared to be a member in national dentist examination. Objectives：Discussion on aspects of Dentistry OSCE exam, and correlations between student’s OSCE score and performance in clinical practice. Methods：This study was undertaken by longitudinal follow-up study design, included 52 sixth grade dentistry students from certain southern medical university from 2012 May to 2013 May. Using OSCE (Objective Structured Clinical Examination) as the method, there are three stations each. The examination(OSCE) is administered prior to clinical training and collect the scores. Then students undergo routine clinical department for one year internship and collect the scores from clinical departments. Finally, OSCE is administered again before clinical training completed and collect total scores.We use SPSS version 19.0 software for analysis. Statistical methods: Descriptive statistics, ANOVA, Paired t-test, Reliability analysis, Split-half reliability analysis, Difficulty index analysis, Discrimination index, Factor analysis, Correlation coefficient, Simple linear regression, Multiple regression analysis. Results：Reliability assessment (Cronbach Alpha) of OSCE exam is 0.60~0.75, split-half reliability Spearman-Brown coefficient is between 0.17 to 0.84, within the acceptable range, but some of the questions should be modified.In the OSCE exam questions analysis, combined with the results of the difficulty index and the discrimination analysis, Cronbach Alpha value can be increased to 0.63~ 0.76. The average score for each clinical department between 84.39 ~ 88.71 points, pre-test and post-test OSCE mean scores were 162.40 and 181.27 points, while the average pre-test and post-test OSCE score difference was 18.87 points, standard deviation was 39.64 points (P <0.001). OSCE pre-test scores and Periodontology Department (r = 0.30, p = 0.032), General Dentistry Department (r = 0.33, p = 0.017) were positively correlated. OSCE post-test scores and Preservation Department (r = 0.36, p = 0.009), Prosthodontics Department (r = 0.34, p = 0.015) and Periodontology Department (r = 0.27, p = 0.041) have positive correlation trend. Conclusion：Student’s OSCE scores have significantly increasing trend after a one-year student clinical internship training. Internal consistency and stability of OSCE exam questions can be evaluated by combined with the difficulty index and the discrimination analysis, and factor analysis can be used as one of OSCE exam validated methods.Individual technique can significantly enhance while clinical practice completed. But in the doctor-patient communication and the X-ray image interpretation aspect is to be strengthened. In suggestion, communication skills and the ability to interprete the image should be reinforced during the future internship training program.