如何成為一位好的臨床技能考官

近年來醫學教育的評估方法有很大的改變，從傳統的紙筆測驗知識轉向較複雜化的系統性評估。我們可以從四個層次來評價受訓者的臨床技能，分別為知道、知道為什麼、可以展現出來讓別人瞭解、以及實踐。其中的「show how」和「do」是無法以傳統的紙筆測驗來評價。1975年Harden首次提出客觀結構化臨床測驗。客觀結構化臨床測驗可以可靠且有效的評估臨床技能，而且廣泛地使用在評估健康照護提供者的臨床升任能力。自2013年起，客觀結構化臨床測驗被納為台灣醫學生醫師執照考試的一部分。評估臨床勝任能力是一項至關重要的任務，這會決定學生是否能夠進展到更高階的學習或是能否取得醫師資格考。然而以考官為基礎的評分方式通常會表現出心理上的弱點。造成評分者偏差的原因有很多，這些變異的來源統稱為評分者效應。因此，考官在提供一個可靠和公正評核的過程中扮演重要角色。本文旨在介紹考官的責任和認識常見的評分者效應。

關鍵字

客觀結構化臨床測驗；考官的責任；評分者的效應

並列摘要

Recently, methods for student assessment in medical education have dramatically changed. We have moved from a tradition of pen-and-paper tests of knowledge and facts toward a more complex system of evaluation. We assess clinical skills of trainee in four levels: know, know how, show how, and do. Performance in the levels of 'show how' and 'do' cannot be assessed with traditional paper-based tests. In 1975, Harden described the first objective structured clinical examination (OSCE). The OSCE has become a reliable and valid assessment of clinical skills and used extensively in evaluating clinical competence in the health care providers. Since 2013, the OSCE has been included as part of the Medical Licensing Examination for all medical school graduates in Taiwan. Assessment of clinical competence is a critical task which allows decisions to be on whether students can progress on to higher levels of study or physician qualification examinations. However, rater-based assessments generally demonstrate psychometric weaknesses. There are many causes of rater errors. These sources of variance are collectively called rater effects. Therefore examiners play a vital role in this process in ensuring that the assessment process is reliable and fair. This article aims to introduce the examiner's responsibilities and to identify common rater effects.