應用迷你臨床演練評量於職能治療實習學生之教學評量－以心理領域為例

Using the mini-CEX for Teaching Evaluation in Mental Health Occupational Therapy Clinical Fieldwork

劉怡佳(Yi-chia Liu) ； 黃百川(Pai-Chuan Huang) ； 朱慶琳(Ching-Lin Chu) ； 許瑋云(Wei-Yun Hsu) ； 陳柏熹(Po See Chen) ； 林克忠(Keh-chung Lin)

《臺灣職能治療研究與實務雜誌》 14卷2期 (2018/12) Pp. 61-74

https://doi.org/10.6534/jtotrp.201812_14(2).0001

摘要

目的：職能治療師養成訓練除學校基礎教育外，更須透過臨床實習學習臨床技能。過去臨床實習訓練多採師徒制，透過臨床教師臨床示教並觀察職能治療實習學生技能操作，教師給予回饋，但傳統作法缺乏客觀教學評量以確定教學成效。本研究應用迷你臨床演練評量（mini Clinical Evaluation Exercise, mini-CEX）於心理領域職能治療實習學生之初探研究，目的為：（1）探討mini-CEX應用於職能治療之適用性；（2）透過mini-CEX檢視實習學生學習成效，是否符合實習學生水準；（3）mini-CEX是否可反映心理疾患職能治療實習學生不同接案情境會談實際表現。方法：本研究回溯分析2011年7月至2015年12月間南部某醫學中心40位職能治療實習學生之mini-CEX資料，所得資料以SPSS 18進行各評量項目敘述統計分析，再以成對樣本t檢定（paired sample t test）統計分析前（實習第四周，獨立接案第一案）、後測（實習第十一周，獨立接案第三案）表現的差異，進一步透過相依樣本單因子變異數（ANOVA）分析，分別探討在不同場所，評量所需時間是否存在差異。結果：兩位實習臨床教師完成296次評量，其中4位職能治療實習學生完成5次、36位完成6－9次評量。結果發現，在296次的評估中，評估比例最高的是「醫療面談」達100%，依次為「組織效能」（97.97%），「人道專業」（94.93%），「臨床判斷」（93.92%），「諮商衛教」（53.38%），「身體檢查」（18.24%），「操作技能」項目被評比例最低（6.42%）。另外，受評職能治療實習學生得分居於2至3分，表現較佳分項為「人道專業」、「醫療面談」及「組織效能」，表現較不佳者為「身體檢查」及「諮商衛教」。如依職能治療實習學生學習進展進行分析，可見在日間病房及急性病房接案溝通能力上，在「醫療面談」、「人道專業」、「臨床判斷」及「組織效能」這幾個項度均有明顯進步，且達顯著差異。結論：經此次台灣地區第一個報導職能治療實習學生使用mini-CEX評量的經驗，mini-CEX教學工具用於評量職能治療臨床實習效果，大部分項目皆能被穩定使用，具潛在的實用度，某程度上確實可監測出實習學生在職能治療接案會談時不同面向表現的變化，也能反映實習學生在職能治療接案會談上進展。但本研究結果也顯現出特定項目在內部一致性、心理職能治療情境的適用性上，有不易穩定採用的問題，如：不同評量場所情境及“身體檢查＂與“操作技能＂項目。為維持mini-CEX評估結果的品質，除多鼓勵更多職能治療專業臨床教師熟悉並參與發展改良外，未來宜收集各界專家意見，依據職能治療師的核心能力再去修改項目，持續發展更合適的評量項目與行為指標，以建立標準化、具備信效度的評量工具，設計出更適合職能治療實習學生教學評量的mini-CEX，以做為臨床教學品質提升的參考。

關鍵字

迷你臨床演練評量（mini-CEX） ； 職能治療 ； 醫事教育

並列摘要

Objective: Teaching and evaluation of practice skills in clinical fieldwork is crucial for occupational therapy (OT) internship. Traditional training relies on mentorship, where the trainees observe and duplicate decision making and actions of her/his mentors, and the mentors provide feedback to students' performance. An objective tool for evaluating teaching and learning effectiveness of OT education is needed. Thus, this study aims to evaluate the appropriateness of mini-CEX (mini Clinical Evaluation Exercise) in teaching and learning in OT internship in a mental health setting. Methods: This was a retrospective design study. Data were collected at a medical center in southern Taiwan from July 2011 to December 2015. Forty OT students under psychiatric internship were evaluated by their mentors. Statistical analyses including descriptive statistics and paired sample t tests were conducted. Narrative information from the students' mentors was studied to help interpret the results. Results: A total of 296 mini-CEX evaluations on student performance were conducted by two supervisors. Data from forty interns were analyzed. Thirty-six OT interns involved in 6~9 evaluations individually. And the rest of four OT interns involved in 5 evaluations. Among all evaluations, the most frequently evaluated skills were medical interviewing (100%), organization/efficiency (97.97%), humanistic qualities/professionalism (94.93%), and clinical judgments (94.93%), followed by counseling (53.38%), physical examination (18.24%), and clinical competence (6.42%). Acquired scores clustered around 2~3 points, with humanistic qualities/professionalism, medical interviewing, and organization/efficiency at the higher end, and physical examination and counseling at the lower end. As for the improvements from the pre- to post-evaluations, medical interviewing, humanistic qualities/professionalism, and clinical judgment skills achieved statistical significance. Conclusions. Mini-CEX could be a practical tool for OT education for interns. Our results reveal that some skills listed in the mini-CEX could be consistently assessed in OT education, while certain skills (i.e. physical examination and clinical competence) may often be omitted due to its lack of applicability. Our results suggest that, while utilizing objective evaluation tools, such as the mini-CEX, commonly used across professions may facilitate communication among professions when evaluating interns' learning effectiveness, we should use it with caution as certain items may not suitable to OT education.

並列關鍵字

mini-CEX ； Occupational therapy ； Allied health education