客觀性結構式臨床技能測驗(objective structured clinical examination;簡稱OSCE)已是當今世界各國醫學教育主流測驗工具。目前國內缺乏相關經驗及參考文獻,以致於推展醫事放射學生OSCE課程不易,極需建構一套標準流程及研究方法。 自民國97年7月至民國99年6月,本研究選擇超音診斷技術為主題,以醫事放射實習學生為對象,每梯次安排三週OSCE教學課程,並設計模擬的臨床場景與考題,於第一、三週分別安排OSCE形成性(formative test)及總結性評量(summative test),以客觀的評估學生的操作技巧與態度反應。於測驗中採用立即回饋的教學方法,提高學生的學習成效。並於評量後招開檢討會議,以雙向回饋方式提昇老師之教學技巧與教學品質,以達到教學相長師生雙贏。 兩年期間共64位醫事放射實習學接受OSCE。經三週OSCE教學後,91.7%實習學生對於臨床能力評估項目,能達到一般水準及以上,而且55.3%實習學生亦能進步到「良好」及「優異」之程度。學生滿意度調查顯示,無論於課程、評核教師及學員受測心得等方面,學生對認為「好」與「非常好」的百分率均佔94%。顯示學生對OSCE教學課程有高度的認同。由本研究測驗結果可看出,學生對於儀器之特殊功能、解剖及病灶的掃描技術較不熟悉,需要更長時間超音波掃描練習,同時也要加強核心課程之教導,建議學校應增加解剖的教授。OSCE形成性評量對實習學生確實有發生前導作用,可改善往後之學習,提升後期測驗成績。 本研究結論,超音波診斷技術之OSCE教學測驗課程,是適合目前醫事放射學生之超音波診斷實習教學與評核,而且OSCE形成性評量是必要的。
Objective : Objective structured clinical examination (OSCE) teaching curriculum is the mainstream method for evaluating medical practice objectively in medical schools and teaching hospitals. The goals of this study were to assess the feasibility of OSCE in diagnostic ultrasonography(US). Materials and Methods: From July 2008 to June 2010, 64 radiological technology students assigned to the department of radiology of Taichung Veterans General Hospital, Taiwan, for internship were enrolled. The diagnostic US teaching curriculum for all students was totally 3 weeks. In 14 students (group A), only summative OSCE were performed. Formative and summative OSCE for 50 students (group B) were carried out in the first and last week of the courses respectively. Wilcoxon signed-rank test was used to assess the difference between formative and summative OSCE in group B students, and the difference of summative OSCE between group A and group B. Results: In group B students, the summative OSCE scores were upgrading in most students, 84.8%, 87.4% , 89.8%, and 94.7% were in part I , part II , part III , and part IV. respectively. The difference of mean scores between formative and summative OSCE for four examination parts were statistically significant (p < 0.0001). The mean summative OSCE scores of group A versus group B were 3.01 vs 3.61 (part I), 3.10 vs 3.88 (part II), 2.77 vs 3.57 (part III), and 2.88 vs 4.07 (part IV.). Significant differences were found at p value less than 0.005. Conclusion: The OSCE is applicable in diagnostic US. The formative OSCE not only shows to students what to learn but also provides information for tutors how to teach.
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