建立多元化評估方式於實習藥學生之學習成效

Setting up Multiform Assessments to Assess Learning Outcomes of Pharmacy Interns

顏志和(Chih-Ho Yen) ； 陳秀美(Hsiu-Mei Chen) ； 劉媖媚(Ying-Mei Liu) ； 吳明芬(Ming-Fen Wu) ； 湯念湖(Ni-Hu Tang) ； 陳本源(Been-Yuan Chen)

《臺灣臨床藥學雜誌》 20卷2期 (2012/06) Pp. 81-102

摘要

目的：國內目前對於藥學實習生評估大都採用筆試與口試。而醫學教育界公認有效的臨床能力測驗方法包括操作技能直接觀察評估（direct observation of procedural skills, DOPS）、迷你臨床演練評量（mini-clinical evaluation exercise, Mini-CEX）及客觀結構化臨床考試（objective structured clinical examination; OSCE）等，這些是以執行為基礎的評估方式。因此我們嘗試建立多元化評估方式評估實習藥學生之學習成效。方法：本研究係以98學年度實習藥學生為對象，於實習期間使用本部建立之DOPS、Mini-CEX及OSCE等模式；由教師設計條列式表單，根據學生在各重點項目的表現予以評分及回饋，也藉由學生接受評量前後的自評分數了解學生的學習成效。並設計問卷比較同時期本院及他院的實習生是否接受此多元評估的差異。結果：執行DOPS結果：包括住院單一劑量藥車調劑、急診處方調劑、小兒科藥品磨粉作業及化學治療藥品配製，學生進行評估前後之自評分數（1～10分）比較，分別增加2.22 ± 1.52、2.53 ± 0.74、2.92 ± 1.50 及2.90 ± 1.48分。執行Mini-CEX結果：以病患出院用藥指導為例，學生進行評估前後之自評分數，增加2.45 ± 1.05分。學生進行OSCE評估前後之自評分數比較，糖尿病病患藥物諮詢與指導，由5.13 ± 1.23增加為7.46 ± 1.14分（p＜0.001）；腎臟移植住院病人藥物諮詢與指導，由5.33±1.46增加為7.21 ± 1.18分（p＜0.001）。問卷調查結果：本院及他院的實習生對各院教學評估滿意度（1～5分）分別為4.07 ± 0.78與3.18 ± 0.76分（p＜0.001）；專業技能幫助度方面分別為4.22 ± 0.80 與3.75 ± 0.75分（p＜0.002）；有無執行Mini-CEX及OSCE前後自評比較，有執行這組在與病人溝通技巧、醫病關係技巧、臨床技能和臨床問題解決能力方面皆有顯著增加（p＜0.05）。結論：配合傳統筆試與口試，再加上新建立的DOPS、Mini-CEX與OSCE形成多元化評估方式進行教學，確實能夠提昇實習藥學生之學習成效。讓藥學教育對學生的知識、技能、態度及藥學倫理能進行更有效的指導與評量，以期培養出稱職且適任的藥師，持續提供有價值的健康服務，並使藥師得到民眾的尊重。

關鍵字

評估方式 ； 實習藥學生 ； DOPS ； Mini-CEX ； OSCE

並列摘要

Objective: Performance-based tools, including direct observation of procedural skills (DOPS), mini-clinical evaluation exercise (Mini-CEX) and objective structured clinical examination (OSCE), have advantages over other forms of traditional assessment (including written examinations and oral examinations). Therefore, we attempted to set up multiform assessments to assess learning outcomes of pharmacy interns during training time. Methods: During the first half year of 2010, our pharmacy interns received three forms of assessment, including DOPS, Mini-CEX and OSCE models. Using global rating scales scores and key point checklists, students' performance were evaluated and feedback immediately and reciprocally. In addition, student's self-rating before and after each assessment were compared to understand the effectiveness of learning. We also conducted a questionnaire study to analyze the differences of multiform assessments between our pharmacy interns and other hospital's in the same period. Results: In DOPS assessment, including Unit dose drug dispensing, emergency drug dispensing, pediatric drug milling operations and preparation of chemotherapy drug; the scores of the student's self-rating were compared before and after each assessment (1 to 10), that increase with 2.22 ± 1.52 , 2.53 ± 0.74, 2.92 ± 1.50 and 2.90 ± 1.48 points, respectively. In Mini-CEX implementation, the patient discharge medication education for example, the scores increase with 2.45 ± 1.05 points. In OSCE assessment, the scores rise significantly from 5.13 ± 1.23 to 7.46 ± 1.14 points (p ＜0.001) in the diabetics patient education station and that rise from 5.33 ± 1.46 to 7.21 ± 1.18 points (p ＜0.001) in the renal transplant patient education station. Analyzing the questionnaire study, it showed that the degree of satisfaction with various teaching evaluation (1 to 5) in our students were significantly higher than those in other hospital pharmacy interns, 4.07 ± 0.78 vs 3.18 ± 0.76 points (p ＜0.001); the same results appeared in promotion of professional skills(4.22 ± 0.80 vs 3.75 ± 0.75, p ＜0.002). Conclusions: From this study, we found that implementation of multiform assessment for pharmacy interns indeed enhance effectiveness of learning outcomes. Based on these practical pharmaceutical educations, pharmacy interns can learn knowledge, skills and attitude, and become a competent pharmacist to provide valuable healthcare service.

並列關鍵字

Assessment ； Pharmacy Interns ； DOPS ； Mini-CEX ； OSCE