耳鼻喉科住院醫師「學習里程碑」之半年階段性評量

Semiannual Staged Assessment of Milestone Project for Otolaryngologic Resident Physicians

陳正文(Jeng-Wen Chen) ； 陳一嘉(Yi-Jia Chen) ； 張淳翔(Chun-Hsiang Chang) ； 王守仁(Shou-Jen Wang) ； 李嘉欣(Chia-Hsin Li) ； 蘇家弘(Chia-Hung Su) ； 廖伯武(Po-Wu Liao) ； 鄒繼群(Chi-Chun Chou) ； 劉嘉銘(Chia-Ming Liu) ； 林凱南(Kai-Nan Lin) ； 林世倉(Shih-Tsang Lin)

《台灣耳鼻喉頭頸外科雜誌》 53卷2期 (2018/06) Pp. 48-57

https://doi.org/10.6286/jtohns.201806_53(2).048

摘要

背景與目的：運用本院導入之中文版耳鼻喉頭頸外科「學習里程碑」評量方法，進行半年階段性評量，呈現並比較本院住院醫師於訓練過程中，美國畢業後醫學教育評鑑委員會六大核心能力的量化學習進程。方法：中文版耳鼻喉頭頸外科「學習里程碑」評量系統包含21項「次核心能力」，每項分5階階有1-6個里程碑，共368個里程碑。本院於2017年7月及2018年1月分别進行住院醫師評量，兩次評量均完成住院醫師自評、總醫師及主治醫師複評，並記錄評量所需時間。以雙樣本中位數差異檢定比較兩次主治醫師複評所需時間及評量結果，並使用組内相關係數分析比較重複量測的信度，作爲臨床能力評估委員會回饋之量化依據。結果：主治醫師兩次複評所需平均時間無統計學上顯著的差異。21項「次核心能力」主治醫師兩次複評的里程碑總分分别爲：R2（43.4±3.8; 47.0±5.6, p-0.025），R3（53.6±5.8; 59.4±7.6, 0.002），R4（60.6±9.8; 67.8±89, p = 0.006），R5（65.7±7.3; 72.1±8.2, p = 0.008），住院醫師自評、總醫師及主治醫師複評所需時間均介於15-30分鐘。組内相關係數分析比較主治醫師兩次複評的重複量測信度高0.66（95％信賴區間，0.52-0.77）。結論：由間隔半年之兩次階段性評量結果發現，個別住院醫師在六大核心能力的學習進程雖有差異，但里程碑總分均呈現明顯進步，達統計學上顯著意義，計畫主持人可依據此結果掌握住院醫師學習情形，適時加強輔導，展現「學習里程碑」評量之成效。

關鍵字

milestone ； core competency ； the Accreditation Council for Graduate Medical Education ； subcompetency ； the Clinical Competency Committee（學習里程碑 ； 核心能力 ； 美國畢業後醫學教育評鑑委員會 ； 次核心能力 ； 臨床能力評估委員會）

並列摘要

BACKGROUND: We used the Chinese version of the Otolaryngology Milestone Project as a framework of assessment for resident physicians. Semiannual staged evaluations were conducted to determine quantitative changes in learning progress regarding the six core competencies defined by the Accreditation Council for Graduate Medical Education (ACGME) for assessing resident physicians during their training. METHODS: The Chinese version of the Otolaryngology Milestone Project addresses 21 subcompetencies. Each subcompetency has five levels, and each level has one to six milestones. There are thus 368 milestones in total. We conducted the first and second assessments of resident physicians in an otolaryngology department in July 2017 and January 2018, respectively. The two assessments were performed through resident doctors’ independent self-evaluations, which the chief resident physicians and attending physicians reevaluated independently. The average time required for each of the two assessments was recorded, and a Wilcoxon rank-sum test was used to compare the results of the two assessments. Test-retest reliability was determined with intraclass correlation coefficient. The results serve as quantitative evidence with which Clinical Competency Committees can provide feedback. RESULTS: Results: The average time required for completion of the independent reevaluation by the attending physicians did not differ between the two assessments. The total milestone scores in the two assessments of 21 subcompetencies were as follows for residents R2-R5: R2 (43.4 ± 3.8; 47.0 ± 5.6, p = 0.025), R3 (53.6 ± 5.8; 59.4 ± 7.6, p = 0.002), R4 (60.6 ± 9.8; 67.8 ± 8.9, p = 0.006), and R5 (65.7 ± 7.3; 72.1 ± 8.2, p = 0.008). The average time required for completion of the independent self-assessment by resident physicians and the independent reevaluation by the chief resident physicians and the attending physicians was 15 to 30 minutes. The intraclass correlation coefficient was 0.66 (95% confidence interval, 0.52-0.77). CONCLUSIONS: The results of two semiannual staged assessments revealed that minor difference existed among individual resident physicians. However, all resident physicians showed significant improvement. The program directors can use these results to understand the learning progress of all resident physicians and provide timely counseling. The results also demonstrate the effectiveness of the Milestone Project.

並列關鍵字

milestone ； core competency ； the Accreditation Council for Graduate Medical Education ； subcompetency ； the Clinical Competency Committee