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摘要


背景:能力導向醫學教育(competency-based medical education)是未來醫學教育的典範,而「學習里程碑」評量則是達成能力導向醫學教育的方法之一。台灣版「耳鼻喉頭頸外科學習里程碑」於2017年完成,並於2019年起試行多中心評量,評量過程需耗用大量人力、物力及時間,因此著手建構線上自動化的學習里程碑評量系統。方法:我們先運用Google表單將台灣繁體中文版「耳鼻喉頭頸外科學習里程碑」電子化,為各訓練醫院的客制化評量表單,並撰寫Google雲端運算服務應用程式,建立線上自動記分及表單分發流程,使系統成員能隨時隨地進行自評或複評,無需自行計算分數,再結合社群軟體功能進行聯繫工作,包括基本資料登入與里程碑表單的傳送等,評量完成後自動產生報表,提供訓練醫院計劃主持人參考,系統完成後共進行兩次多中心學習里程碑評量。結果:線上自動化里程碑評量系統與紙本作業流程相同,均可呈現住院醫師六大核心能力之進程,但線上自動化系統大幅減少紙資源的使用,計分錯誤比例由7.6%降為0%,學員及臨床教師的評量流程平均滿意度為4.7±0.5及4.8±0.4(李克特量表,1-5分,5分代表非常滿意),填寫紙本表單與電子表單所需時間無顯著差異。結論:本研究建構並導入線上自動化的多中心學習里程碑評量流程,實際執行結果已證實其可行性,能解決不同訓練醫院評量結果無法互通的現況,而且,本研究所使用的所有線上資源都是免費的。

並列摘要


BACKGROUND: Competency-based medical education is becoming critical in the training of future health care professionals. Milestone assessment is one approach to achieving this goal. We launched the Taiwanese traditional mandarin version of The Otolaryngology Milestone Project in 2017. Multicenter evaluations were piloted in 2019. The assessment process requires considerable workforce, paper resources, and time. Therefore, we developed and implemented an online automated milestone assessment system. METHODS: First, we developed an electronic version of the paper-based milestone assessment form using Google Forms, which was customized for each training program. We subsequently wrote a Google App Script–based cloud computing program to establish an online system that permits automatic distribution of self-evaluation and reevaluation forms, allowing the participant to access and edit these documents anytime and anywhere without the need to calculate the score by themselves; they could thus focus only on the description of each milestone. The online system communicates automatically with social software, which processes the login information and transmission of the milestone forms. Once the evaluation is completed, reports are generated automatically and sent to the program directors for analysis. All the results are stored in Google Drive via cloud computing. This online automated workflow has been used in multicenter milestone evaluation since 2020. RESULTS: Both online and paper-based grading systems can demonstrate the progress of the six core competencies of otolaryngology resident physicians, but the online automated system significantly reduces paper use, and the scoring error rate was reduced from 7.6% to 0%. The average user satisfaction measured on a 5-point Likert-type scale was 4.7 ± 0.2; no significant difference was observed in the time required to fill in the paper form and the electronic form. CONCLUSIONS: Our online automated multicenter milestone evaluation workflow was found to be reliable for assessing the milestones. Using this approach, we can compare the attainment of the core competencies by resident physicians in different institutions without the limitations of individual health care information. Moreover, all these online resources are free of charge.

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