利用森林圖呈現客觀臨床能力測驗（OSCE）的考生成績：Rasch分析

Using forest plots to present the performance sheets provided to OSCE examinees using Rasch analysis

楊道欣(Daw-Hsin Yang) ； 錢才瑋(Tsair-Wei Chien) ； 林瑞中(Jui-Chung John Lin) ； 劉佩琪(Pei-Chi Liu)

《醫療資訊雜誌》 30卷1期 (2021/03) Pp. 1-12

摘要

客觀結構化臨床檢查（OSCE）已成為評估醫療機構臨床技能的可行方法。相較之下，卻未見到使用視覺化的圖示系統，來呈現OSCE的考生成績。我們搜集29位在2018年參加OSCE的醫學院學生（簡稱醫學生）成績，共計12個站。採用連續Rasch模式（CRM）來估計受試者的成績和標準誤。與其他兩情境（即二元和混合計分）相比較，解釋CRM的特徵。繪製統合分分析常用的森林圖，顯示這29人和五子群分組（學校）的OSCE成績。我們使用線上CRM繪製森林圖，並觀察到（1）二元計分情境的測量範圍最寬，其次是混合計分情境。CRM的百分比計分與另兩情境的比較，說明CRM情境的原始總分較小，符合預期具有較小的測量範圍（-0.42至0.38）和題目測量分數（即難度）（-0.48至0.41）；（2）所有OSCE醫學生間的成績，未呈顯著差異，且未小於零（即95％信賴區問，未小於logit為零分的中心線）；（3）在本研究的五校中，台北醫學學校的學生表現最優。我們設計兩個線上資料訊模組，用來（1）估計考生的成績和標準誤，再用成績和標準誤（2）繪製森林圖，以顯示醫學生的視覺圖成績，有助於在未來醫院，能夠有效且客觀地評估學生在醫院實習的OSCE成果，不再僅限於醫學系的學生。

關鍵字

OSCE ； 臨床技術 ； 連續Rasch模式 ； 資訊模組 ； 森林圖

並列摘要

The objective structured clinical examination (OSCE) has become an acceptable method for evaluating clinical skills in healthcare settings. However, none of the current literature were seen using visualization plots to compare individual OSCE performances. We obtained data from 29 medical students who participated in OSCE examinations in 12 stations in 2018. The continuous Rasch model(CRM) was applied to estimate person measures and standard errors(SE). The characteristics of the percentage CRM were interpreted in comparison to the other two counterparts(i.e., binary and mixed scenarios). Forest plots frequently used in Meta-Analysis were drawn to display those 29 examinees and five subgroups. We used online CRM to draw forest plots and observed that (1) the binary scenario has the wider range in measures, followed by the mixed scenario. The percentage mode as expected has narrower ranges in person abilities(from -0.42 to 0.38) and item difficulties(from -0.48 to 0.41) owing to smaller total raw scores when compared to the other two counterparts;(2) all OSCE performances of medical students do not deviate from the middle line with zero logits; (3) The students in Taipei Medical University outperformed other schools among the five subgroups. We designed two online computer module for (1)estimating person measures and SEs, and (2) drawing forest plots to display the OSCE performance sheets for Taiwan medical students, which helps hospitals evaluate OSCE performances for students efficiently and objectively, but such results are not limited to medical students in the future.

並列關鍵字

OSCE ； clinical skills ； continuous Rasch model ； computer module ； the forest plot