臨床醫學教育與Mini-CEX

Clinical Medical Education and Mini-CEX (Clinical Evaluation Exercise)

陳偉德(Walter Chen) ； 蔡長海(Chang-Hai Tsai) ； 黃崑巖(Kun-Yen Huang)

《Journal of Medical Education》 9卷4期 (2005/12) Pp. 74-81

https://doi.org/10.6145/jme.200512_9(4).0009

摘要

師徒制是臨床醫學教育所特有的，但國內外的調查卻皆顯示相當多數的醫學生或住院醫師，從未在主治醫師的直接觀察下從事醫療技能的操作。美國內科醫學會所發展的「迷你臨床演練評量(mini-CEX)」係由一位主治醫師直接觀察住院醫師對病人做重點式的臨床診療工作，並於結構式表單上根據醫療面談、身體檢查、人道專業、臨床判斷、諮商衛教、組織效能、及整體臨床稱職等項目給予評分，並給予即時的回饋；其特點是可在例行的門、急診或住院工作中同步進行，僅需費時20-30分鐘，可行性較高，而且係經由不同的主治醫師評量，其信效度亦較優良。希望藉著引進mini-CEX，能使台灣的臨床醫學教育達成醫學教育白皮書中所要求的目標。

關鍵字

教學評量 ； 回饋 ； 直接觀察 ； 迷你臨床演練評量

並列摘要

Clinical medical education is unique for its apprenticeship. Domestic and international investigations, however, have shown that a lot of medical students and residents have never been direct observed during their perfomiance of basic clinical skills. To facilitate directly observation of these core skills that residents demonstrate when they meet patients, the American Board of Internal Medicine developed the mini Clinical Evaluation Exercise (mini-CEX). Using a 9-point scale, the examiner rates the resident on their medical interviewing skills, physical examination skills, humanistic qualities/professionalism, clinical judgment, counseling skills, organization/efficiency and overall clinical competence. The examiner also provides real time feedback to the trainees. The mini-CEX can be easily implemented by attending physicians as a routine and seamless evaluation of a resident in any setting, whether ambulatory, emergency department, or inpatient. The time taken for this assessment is usually between 20-30 minutes and this makes it highly feasible. Based on multiple encounters with different patients and different observers, this method provides a valid and reliable measure of the residents performance. It is hoped that the introduction of the use of the mini-CEX to Taiwan will help clinical medical education in this country reach the required goals set by the Ministry of Education.

並列關鍵字

student assessment ； feedback ； direct observation ； mini Clinical Evaluation Exercise mini-CEX

參考文獻

楊培銘(2001)。理想的臨床教學能在台灣實現嗎？。醫學教育。5，271-272。

黃崑巖、賴其萬(2003)。醫學教育白皮書－台灣醫學教育之改進方向。教育部醫學教育委員會。

財團法人國家衛生研究院醫學院評鑑委員會

ACGME Outcomes Project

蔡景仁(2001)。門診教學心得。醫學教育。5，73-76。