以“主題結構化群組臨床測驗”評量“臨床診斷學”教學成效

陽明大學醫學系於88年度引進「主題結構化群組臨床測驗」(Group Objective Structured Clinical Examination, GOSCE) 架構，於期末評量同學「臨床診斷學」之學習成效，本研究即用來評估GOSCE測驗對同學所造成之影響。共八科16個GOSCE測驗站，由同學自行分成16組。總計119名醫四學生及32名指導者（含模擬病患及評核教師）參與此實驗。小組成績一致以圑隊於各科正確完成之「考核項目百分比」平均計，並利用自填式問卷作為本次GOSCE測驗評值。測驗結果同學平均成績為92.4±2.31，各組團隊考核項目完成率多高於九成以上，與指導者期待之教學成果（100%完成率）相接近。經由團隊其他成員協助完成之考核項目，在八個不同科別均有明顯差異，顯示圑隊合作對提高團體成績的確有所助益。學生及指導者問卷回收率分達98.3%及87.5%。全體參與者對測驗方式整體意見大致為滿意。有高達90.6%的學生認為下年度應該續辦GOSCE測驗。A，B兩場地學生成績有明顯差異，顯示同一科A，B兩場地教師評分標準並不一致。不同場地同學們對擔任該場地評核教師及模擬病患的評分有明顯差異，這些評分的差異與團隊該科所得成績優劣無關。總結此次運用GOSCE測驗評量「臨床診斷學」教學成效的實驗是成功且受參與者肯定的，但需進一步建立評核教師評比成績之標準及共識。

關鍵字

醫學教育；評量；教學評量；模擬病人

並列摘要

Group objective structured clinical examination (GOSCE), a method used to improve the medical teaching quality, was implemented to the fourth-year medical students in National Yang-Ming University in 1999. Here we describe and evaluate the overall feedback received from the faculties and the students involved in this examination. The study subjects were composed of 119 fourth-year medical students and 32 instructors (including the simulated patients and the evaluation staff). The students were grouped into 16 GOSCE stations of which 8 clinical departments were entailed. Each group's rating was aver aged from the 'percentage of items performed correctly' in each department. The average score of the students is 92.4±2.31 and the average percentage of items completed by each group is more than 90%, which is very close to the expected teaching performance, 100%. In all the departments included in this study, there is a significant difference between the items completed by a student alone or with the assistance of other members in the same GOSCE group (Wilcoxon paired ranks sign test, Asymptotic significant p value＜0.05), indicating that a better teamwork is attributable to a higher GOSCE score. The students and the instructors, with the questionnaire-returning rate of 98.3% and 87.5%, favorably accepted the use of GOSCE and the overall test format respectively. More than ninety percent (90.6%) of the students recommended performing another GOSCE next year. The mean scores from evaluators and students located at different places in the same department exhibited distinct difference (Mann-Whitney Utest, Asymptotic significant p＜0.05), suggesting an intra-departmental variation in this examination. However, these evaluation differences were not related to the score rating. In conclusion, the implementation of GOSCE in the assessment of 'Clinical Examination' teaching was successful and positively supported. It is recommended, however, the inclusion of an unified scoring system for the instructors in using the GOSCE method.

並列關鍵字

clinical medical education ； teaching assessment ； slmulated patients

國際替代計量

以“主題結構化群組臨床測驗”評量“臨床診斷學”教學成效

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