迷你臨床演練評量之效度研究－輔醫經驗

Validity of the Mini Clinical Evaluation Exercise-Experience at the Fu-Jen Catholic University

葉建宏(Jiann-Horng Yeh) ； 邱浩彰(Hou-Chang Chiu) ； 鄒國英(Kuo-Inn Tsou) ； 周定遠(Ting-Ywan Chou) ； 陳偉德(Walter Chen)

《Journal of Medical Education》 11卷1期 (2007/03) Pp. 39-46

https://doi.org/10.6145/jme.200703_11(1).0005

摘要

「迷你臨床演練評量(mini-CEX)」係由美國內科醫學會(ABIM)所發展之臨床評量，由一位臨床老師直接觀察住院醫師或醫學生對病人做重點式的臨床診療工作，並於結構式表單上給予評分及回饋。為凝聚臨床老師之評分共識，輔大醫學系自民國95年4月陸續舉辦9場評分訓練工作坊，共計培訓169位臨床老師。本文針對學員在工作坊後實際評量3段ABIM官方影帶之結果加以分析。結果發現，雖然3段影帶的分數分布都有跨3個等類，但分布在極端等類的人數，畢竟少數（2至5%）。在ABIM之建議答案為標準下，全部169位老師看完3段影帶後，意見相同者共有217段影帶占43%。整體而言，學員評分比ABIM 稍高。尤其在「醫療問診」及「諮商衛教」項目。「身體檢查」部分，則有近一半老師評分較ABIM評分苛。mini-CEX七個評分項目中無論是個別項目的相關性或個別項目與「整體適任」之相關性都有顯著關聯性，細項中「醫療面談」與「整體適任」相關性稍低。總結，針對輔大醫學系老師對mini-CEX影帶試評結果發現，老師間看法差異不大，穩定度可。在台灣推行mini-CEX評量制度，透過此種精簡的工作坊後，應可以有效凝聚老師間的評分共識。

關鍵字

迷你臨床演練評量 ； 直接觀察 ； 效度

並列摘要

The American Board of Internal Medicine (ABIM) developed the mini Clinical Evaluation Exercise (mini-CEX) in order to evaluate resident's skills through direct observation of a focused clinical examination in a real patient using a structured rating scale and immediate feedback. To achieve consensus on the rating, we organized nine consecutive workshops involving a total of 169 clinical teachers beginning in April 2006 at the College of Medicine, Fu-Jen Catholic University. By analyzing the rating scores on the three ABIM-authorized videotapes after a 4-hour workshop, we found only a few examiners (2% to 5%) could not distinguish between unsatisfactory and superior levels of performance, although there was a distribution of scores across all three levels. Based on the answers provided by the ABIM-authorized videotapes, the concordant rate between the Taiwanese examiners and ABIM was 43% over a total of 217 taped performances. In general, the Taiwanese examiners gave a higher level of performance than the ABIM, especially in the categories of medical interviewing and counseling. In contrast, nearly half of the Taiwanese examiners rated more critically the category of physical examination. The category of overall clinical competence correlated well for all six detailed categories, with the weakest correlation being in the medical interviewing category. In summary, discrepancies in rating among the clinical examiners were not obvious during our study. Thus, it can be concluded that a consensus on clinical rating can be effectively achieved through the concise and structured workshop approach used here.

並列關鍵字

mini Clinical Evaluation Exercise ； direct observation ； validity

參考文獻

陳偉德、蔡長海、黃崑巖(2005)。臨床醫學教育與Mini-CEX。醫學教育。9，74-81。

Durning SJ,Cation LJ,Markert RJ(2002).Assessing the reliability and validity of the mini-clinical evaluation exercise for internal medicine residency training.Acad Med.77,900-904.

Hauer KE(2000).Enhancing feedback to students using the mini-CEX (Clinical Evaluation Exercise).Acad Med.75,524.

Holmboe ES,Huot S,Chung J(2003).Construct validity of the miniclinical evaluation exercise (miniCEX).Acad Med.78,826-830.

Kogan JR,Bellini LM,Shea JA(2002).Implementation of the mini-CEX to evaluate medical students' clinical skills.Acad Med.77,1156-1157.