應用客觀結構式臨床測驗診斷職能治療臨床實務能力之研究

Application of Objective Structured Clinical Examination to Diagnose Clinical Competencies in Occupational Therapy

洪佳慧(Chia-Hui Hung) ； 林陳涌(Chen-Yung Lin)

《職能治療學會雜誌》 31卷2期 (2013/12) Pp. 145-173

https://doi.org/10.6594/JTOTA.2013.31(2).02

摘要

客觀結構式臨床測驗（objective structured clinical examination, OSCE）常被用以評量重要的臨床實務能力，本文目的為探討心理疾病職能治療執行的OSCE之測驗信效度，並聚焦於學生測驗結果之分析與檢討，以提供課程發展與改進。本研究之OSCE備有5個考站，以實際臨床會談情境與標準病人互動，從而評估學生之臨床實務能力表現。參與者為109位即將進入臨床實習，已修畢相關課程之職能治療五專四年級生。資料分析以項目分析與因素分析檢驗本次OSCE品質與潛在的能力組成。結果顯示經項目分析後剔除未達標準之4項，剩下39個評分項目，整體Cronbach's α為.88。因素分析結果顯示本測驗所含括的七個主題，可解釋的變異量為54.5%，分別為介入安排、諮商技術、需求確認、基準評估、資料收集、醫病關係建立和倫理議題。由學生表現發現，計有32位學生沒有通過（29.4%），學生在諮商技術、醫病關係以及資料收集等一般臨床實務能力的表現較佳。不過，在需求確認、介入安排，以及基準評估等操作性臨床技術尚待加強，也需在課程中加以關注。建議課程規劃可在教學模式中，嘗試融入情境式的臨床技能操作訓練以提升學生專業能力。此外，針對OSCE，亦提出出題者應兼顧臨床實務與測驗情境下評分項目的適合度，考官應增加客觀考評之能力等建議，以提升測驗效度及OSCE品質。

關鍵字

客觀結構式臨床測驗 ； 心理疾病職能治療 ； 臨床實務能力 ； 課程

並列摘要

Objective structured clinical examinations (OSCEs) have been used to assess the key clinical competencies of the many health professions, but the experience of occupational therapy is relatively unexplored. This paper studies the validity and reliability of the OSCE in the domain of mental health occupational therapy, and focuses on students' performance in OSCE to improve the curriculum. A five stations OSCE was administered to all 109 students to assess occupational therapy clinical competencies. Assessors completed the clinical competency checklists, then using item analysis and factor analysis to characterize the quality of OSCE and underlying competencies being assessed. Borderline scores were used to derive pass/fail cutoff scores for the examination. The findings suggest that the Cronbach's α of the OSCE was .88. Item analysis indicated that four checklist items need to be deleted. Factor analysis showed that 7 themes are obtained and the cumulative variance accounted for is 54.5%, they are planning an intervention, consultation skills, identifying needs, baseline assessment, information gathering, building rapport, and ethics issue. According to the borderline scores, there were 11% of the students could perform the tasks correctly and completely; however, 29.5% failed the OSCE. Students have good performance in consultation skills, building rapport, and information gathering, but their skills on identifying needs, planning intervention, and baseline assessment still need to improve. In conclusion, An OSCE is a necessary assessment and training tool that should be continuously applied in occupational therapy education. Based on this study, implications for curriculum development and instructional practice were presented.

並列關鍵字

OSCE ； Mental health occupational therapy ； Clinical competence ； Curriculum