探討基本課程及臨床表現與台灣物理治療師國家考試及格率的關聯性

Investigating Association of Fundamental Courses and Clinical Performance with The Passing Rate of Taiwan National Licensure Examination of Physical Therapy

葉玉和(Yit-Hoe Yap)

指導教授 ： 李建宏

共同指導教授 ： 蕭世芬(Shih-Fen Hsiao)

高雄醫學大學/健康科學院/公共衛生學系公共衛生學碩士班/碩士(2018年)

摘要

研究背景: 自民國85年開始至今，台灣舉辦物理治療師證照考試已有三十多年的歷史，每年及格率約17%。此考試具有篩選物理治療系畢業後的學生是否具有臨床專業操作與知識水準的主要功能，也能夠為台灣物理治療臨床的專業品質進行嚴格把關。但其關於個人臨床能力與知識水準的數據只給予及格與否的絕對標準，無法即時具體回饋給未達及格標準的學生，以供下次改善方向之依據。是以若能有一套評估大學生在學習表現的工具就能及早做出適當的回饋跟改善，藉以促進學生學習表現，提高國家考試及格率和專業素質。雖然傳統教育評估模式一向是台灣主要的選才方式，但是隨著知識革新與時代演進，2010年高雄醫學大學物理治療系引進核心能力導向醫學教育模式的評估工具: 客觀式結構化的臨床表現檢測(Objective Structured Clinical Examination，OSCE)，並實際應用在評估物理治療系學生的臨床表現能力，藉以建立學生OSCE成績的原始資料檔案。因此，本研究旨在探討基本課程及臨床表現兩者與台灣物理治療師國家考試及格率的關聯性，據以提出建議提升未來台灣物理治療師專業能力之參考。
研究方法: 本研究以2011年至2013年入學的物理治療系學生為研究對象的回朔性族群數據分析研究，將其性別、年齡、入學管道、四年相關課程學業成績等變項投入多層調整式線性迴歸分析(adjusted multiple linear regression)，共有七門科目十種評估出來的分數，這些學業成績分別包含傳統模式的評估分數和核心能力導向醫學教育模式的分數。據此得出各科之間的相關性並進行探討。而且，多層調整邏輯式迴歸分析(adjusted multiple logistic regression) 再將眾多變項進行國考及格率預測分析，由此比較: 不同入學管道學生之學業表現、不同教育評估模式之間的分數差異探討、各年級相關課程間關聯性之比較及其與物理治療師國家考試及格率之間的關聯性等項。
分析結果:高醫物理治療系的學生國考及格率為65.8%，兩性間並無明顯差異。外國留學生擁有最低及格率為0.29。通過多層式線性迴歸分析各科目的相關性得到上學期實習與下學期實習具有顯著的相關性 (β=0.452,p<0.05)，而下學期實習與畢業考的OSCE具有顯著的相關性(β=0.328,p<0.05)。使用多組邏輯式迴歸分析得出入學管道之組合 (繁星計畫學生、外國留學生和轉系生) 比指考入學組別有0.071倍的機率考上國考。而且，基礎物理治療的成績[B=1.144,95%CI:(1.004,1.303)] 與下學期實習的成績[B=1.222, 95%CI:(1.012,1.477)]和國考及格率具有顯著的相關性;預測國考及格率的公式分別為p = 1/(1+e^((-5.164+0.084*(score))) )和p = 1/(1+e^((-10.497+0.136*(score))) )。
結論:傳統教育評估模式裡下學期的實習課程和大學二年級的基礎物理治療科目兩者與國家考試及格率具有正向關聯，可藉以偵測出可能會在往後國家考試無法及格的學生，及早進行特定專業知識輔導，以提高其國家考試的及格率並提升物理治療師的素質。至於本研究顯示核心能力導向醫學教育評估模式(OSCE)能更仔細辨別學生間臨床表現能力之差異並給予即時回饋，此模式有助提高未來台灣物理治療師的臨床專業表現。

關鍵字

物理治療 ； 傳統教育評估模式 ； 核心能力導向醫學教育評估模式 ； 台灣物理治療國家考試證照 ； 客觀式結構化的臨床表現檢測(OSCE)

並列摘要

Background: Taiwan National Licensure Examination of Physical Therapy has been implemented since 1996, with over 30 years dedication to ensuring the competence of physical therapists and the quality of professionalism. The average passing rate of the Taiwan National Licensure Examination of Physical Therapy is around 17% annually, therefore the learning outcome is very important for a physical therapy graduate when it comes to taking such examination. The assessment model that used during university become important in assessing and improving student’s learning performance. In addition to the traditional-based education assessment, the Department of Physical Therapy of Kaohsiung Medical University has implemented competency-based education assessment model since 2010 in selected subjects to meet the educational needs in this profession. The purpose of this study is to investigate the association of the learning outcome of those fundamental and clinical courses by examining the scoring correlations among those traditional and competency assessments. The prediction of the passing rate of Taiwan national licensure examination of physical therapy would be made basing on the correlations of these courses.
Methods: This is a retrospective cohort study with three batches of students of the Department of Physical Therapy, Kaohsiung Medical University (entry 2011 to 2013). Adjusted multiple linear regression was used to analyse the correlations among 10 assessment results from 7 selected subjects related to neurological physical therapy from year one to year four. Adjusted multiple logistic regression was used to predict the probability of passing the National Licensure Examination of Physical Therapy with the appropriate logistic model predictors.
Result: The overall passing rate is 65.8%, no significant difference between gender. The oversea student group has the lowest passing rate with 0.29. Multiple linear regression analysis indicates significant related in between Practise 1st and Practise 2nd (β=0.452, p<0.05); between Practise 2nd and Final OSCE (β=0.328, p<0.05). Multiple adjusted logistic regression analysis shows that combination admission group such as STAR program students, oversea students, and transfer students has 0.071 times probability in succeeding Taiwan licensure examination test compare to AST group. Furthermore, FT.PT L [B=1.144, 95%CI: (1.004,1.303)] and Practise 2nd [B=1.222, 95%CI: (1.012, 1.477)] have significant related to Taiwan National Licensure Examination of Physical Therapy. The probability for those subjects in predicting success rate of Taiwan National Licensure Examination of Physical Therapy are p = 1/(1+e^((-5.164+0.084*(score))) ) and p = 1/(1+e^((-10.497+0.136*(score))) ) .
Conclusion: The study shows that Practise 2nd in the Year 4 and Fundamentals in Physical Therapy in the Year 2 are strong predictors for passing the Taiwan National Licensure Examination of Physical Therapy. As for competency-based assessment model (OSCE) is an appropriate tool used for clinical performance assessment due to its wide variance in differentiating student’s clinical performance. This tool might have the potential in improving physical therapist profession.

並列關鍵字

physical therapy ； traditional-based education assessment model ； competency-based education assessment model ； Taiwan national licensure of physical therapy ； objective structured clinical examination (OSCE)

參考文獻

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