實習醫學生的整合性學習評量研究：直接觀察式評量的必要性

Integrated Assessment System for Medical Clerkship: The Necessity of Direct Observation-Type Assessment

葉建宏(Jiann-Horng Yeh) ； 葉炳強(Ping-Keung Yip) ； 邱浩彰(Hou-Chang Chiu)

《台灣醫學》 16卷1期 (2012/01) Pp. 13-20

https://doi.org/10.6320/FJM.2012.16(1).02

摘要

By directly observing learners with patients and providing feedback, faculties help students to improve clinical skills and help patients through better supervision of clinical care. ”Direct observation” assessments include: objective structured clinical examination (OSCE) and the Mini Clinical Evaluation Exercise (mini-CEX). The Department of Medicine, Fu Jen Catholic University developed an integrated assessment system consisted of a total of five categories: learning passports, clinical performance rating, written test, OSCE and mini-CEX. We analyzed the correlation among all these five categories of assessment in their year results for 51 sixth-year students in the school year of 2008. We paid special attention on the correlation between the scores of assessment with the nature of direct observation (OSCE and mini-CEX) and that of the rests of assessment tools. Summated OSCE scores positively correlated with summated passport scores (r=0.30、p = 0.0352), clinical performance ratings (r=0.29、p = 0.0408), and written test scores (r=0.40、p = 0.0034), but all of the correlation coefficient (r value) were around 0.28 to 0.40 with modest correlation. Analyzing individual specialty showed OSCE scores had a good correlation (r= 0.68、p＜0.0001) with mini-CEX scores in the emergency medicine. Summated mini-CEX scores had no correlation with the other four categories of scores. Comparison of thescores between two major teaching hospitals found significant differences in the categories of clinical performance rating and mini-CEX scores, indicating these two categories of scores being more susceptible to subjective ratings from faculty. In addition, regarding the pass or fail in the Medical Licensing Examination, the failed students had a significantly poor written test scores during their clerkship. In summary, both mini-CEX and OSCE, sharing the same nature of ”direct observation” assessment, can compensate the pitfall resulted from simple domain assessment form a sole written assessment. Due to the relatively high discrimination power, OSCE may play the roles of both formative and summative assessment. The leniency of mini-CEX rating in conjunction with timely feedback could provide a better role of teaching instead of assessment. Its value is far higher than the assessment of teaching significance. Through the consecutive mini-CEX practice for accumulated experience, and the formal test with OSCE, the medical students could achieve better clinical skills.

關鍵字

客觀結構式臨床考試 ； 迷你臨床演練評量 ； 直接觀察 ； 臨床評估

並列摘要

By directly observing learners with patients and providing feedback, faculties help students to improve clinical skills and help patients through better supervision of clinical care. ”Direct observation” assessments include: objective structured clinical examination (OSCE) and the Mini Clinical Evaluation Exercise (mini-CEX). The Department of Medicine, Fu Jen Catholic University developed an integrated assessment system consisted of a total of five categories: learning passports, clinical performance rating, written test, OSCE and mini-CEX. We analyzed the correlation among all these five categories of assessment in their year results for 51 sixth-year students in the school year of 2008. We paid special attention on the correlation between the scores of assessment with the nature of direct observation (OSCE and mini-CEX) and that of the rests of assessment tools. Summated OSCE scores positively correlated with summated passport scores (r=0.30、p = 0.0352), clinical performance ratings (r=0.29、p = 0.0408), and written test scores (r=0.40、p = 0.0034), but all of the correlation coefficient (r value) were around 0.28 to 0.40 with modest correlation. Analyzing individual specialty showed OSCE scores had a good correlation (r= 0.68、p＜0.0001) with mini-CEX scores in the emergency medicine. Summated mini-CEX scores had no correlation with the other four categories of scores. Comparison of thescores between two major teaching hospitals found significant differences in the categories of clinical performance rating and mini-CEX scores, indicating these two categories of scores being more susceptible to subjective ratings from faculty. In addition, regarding the pass or fail in the Medical Licensing Examination, the failed students had a significantly poor written test scores during their clerkship. In summary, both mini-CEX and OSCE, sharing the same nature of ”direct observation” assessment, can compensate the pitfall resulted from simple domain assessment form a sole written assessment. Due to the relatively high discrimination power, OSCE may play the roles of both formative and summative assessment. The leniency of mini-CEX rating in conjunction with timely feedback could provide a better role of teaching instead of assessment. Its value is far higher than the assessment of teaching significance. Through the consecutive mini-CEX practice for accumulated experience, and the formal test with OSCE, the medical students could achieve better clinical skills.

並列關鍵字

objective structured clinical examination ； mini-clinical evaluation exercise ； direct observation ； clinical assessment