1、臨床能力的評(píng)量,1,Model of competence,2,Cognition knowledge,Behaviour Skills/ attitudes,Professional authenticity,Miller GE. The assessment of clinical skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S67.,Measurement of each level of the model,3,Action,Performance,Competence,Know

2、ledge,360-Degree,臨床能力評(píng)估工具分類(lèi),筆試paper-based test MCQ, short essay. 口試oral examination Standardized oral exam, CbD/CSR . 情境模擬simulation OSCE, simulator, screen-based simulation, virtual reality. 實(shí)地評(píng)核workplace-based evaluation DOPS, Mini-CEX, PAT, patient survey, MSF(360。).,4,OSCE,Objective 客觀(guān)的 All the

3、candidates are presented with the same test Structured Clinical examination Structured有結(jié)構(gòu)的 The marking scheme for each station isstructured Specific skill modalitiesare tested at each station, eg. History taking, Clinical examination, Explanation, Procedures ClinicalExamination臨床測(cè)驗(yàn) Test of performan

4、ce of clinical skills: not a test of knowledge The competence of “Show How”,5,OSCE定義及發(fā)展,OSCE（Objective Structured Clinical Examination）是以操作為基礎(chǔ)的測(cè)驗(yàn)” 1975年由英國(guó)Dundee大學(xué)Dr. R.M. Harden提出 它是一種在模擬臨床場(chǎng)景下，使用模型、標(biāo)準(zhǔn)化病人甚至病人來(lái)測(cè)試醫(yī)學(xué)生臨床能力的考核方法 同時(shí)它也是一種知識(shí)、技能和態(tài)度并重的綜合能力評(píng)估的方法 。,6,OSCE考試內(nèi)容,病史詢(xún)問(wèn)(History taking) 身體檢查(Physical

5、examination) 溝通技巧(Communication skill) 咨商衛(wèi)教(Counseling 回饋與評(píng)(5-10分鐘) 由學(xué)員找?guī)煈?yīng)試,22,Mini CEX執(zhí)行方式,23,時(shí)間,人員,事情,地點(diǎn),物件,隨時(shí)、每次約1520分鐘,一位臨床老師 一位學(xué)員 一位病患,觀(guān)察學(xué)員臨床技能,病房、門(mén)診、急診、ICU,評(píng)量紀(jì)錄單,DOPS,Direct Observation of procedural Skills 操作型技術(shù)評(píng)量表 由評(píng)分者直接觀(guān)察受訓(xùn)者實(shí)務(wù)性技術(shù)的技巧并給予評(píng)量,24,以DOPS 之Procedures,Venipuncture IV Cannulation Arte

6、rial puncture Blood culture Subcutaneous injection Intradermal injection Intramuscular injection IV injection,Perform and interpret spirometry Urethral catheterization Nasogastric tube insertion Intubation Use of local anesthetics Airway care,25,DOPS的評(píng)分項(xiàng)目,對(duì)適用狀況相關(guān)解剖與技術(shù)程序展現(xiàn)了解 取得 informed consent 展現(xiàn)妥善準(zhǔn)

7、備程序 妥善止痛或安全鎮(zhèn)靜 具程序所需之技能 無(wú)菌技術(shù) 必要時(shí)尋求協(xié)助 程序后序管理 溝通技巧 考慮病人感受與專(zhuān)業(yè)性 執(zhí)行程序的整體能力,26,CbD/CSR,Case-based Discussion (CbD) in England Chart stimulated Recall Oral Examination (CSR) in USA and Canada A kind of standardized oral examination 由考生準(zhǔn)備自己記錄的病歷或病歷摘要 由接受過(guò)訓(xùn)練及有經(jīng)驗(yàn)的教師12位負(fù)責(zé)考問(wèn) 考問(wèn)內(nèi)容: 安排各種檢查的理由 檢查的判讀 臨床發(fā)現(xiàn)的代表意義 診斷 治療

8、計(jì)劃等 考試時(shí)間:為5-10分鐘 考試病歷:共考3-6本病歷或癥摘,27,360oevaluation / MSF,360-Degree Evaluation in USA and Canada 由最近經(jīng)常接觸被評(píng)量者的人評(píng)分 評(píng)分者可包括: 上-主治醫(yī)師、護(hù)理長(zhǎng)、總住院醫(yī)師 下-實(shí)習(xí)醫(yī)師、見(jiàn)習(xí)醫(yī)師 左-其他住院醫(yī)師、護(hù)理人員 右-病人、家屬 Multi-source feedback in England Patient survey (or patient satisfaction questionnaire in USA) Peer assessment tool (PAT) Team

9、assessment of behavior (TAB) 由學(xué)員提名評(píng)分者 包括:導(dǎo)師、教師、護(hù)理、同儕及其他醫(yī)療人員,28,Patient survey,調(diào)查病人對(duì)醫(yī)院、門(mén)診、住院回診的滿(mǎn)意度 針對(duì)醫(yī)師/護(hù)理人員的不同面向做評(píng)估 病人照護(hù)能力 回診時(shí)間 治療計(jì)劃 服務(wù)態(tài)度,29,Peer assessment tool -PAT 評(píng)量項(xiàng)目范例,能辯識(shí)問(wèn)題 能訂妥當(dāng)處置計(jì)劃 了解自己之權(quán)限 能對(duì)疾病之社會(huì)心理層面作反應(yīng) 能妥善使用資源 時(shí)間及優(yōu)先級(jí)安排妥當(dāng) 壓力處理能力,30,執(zhí)行技術(shù)正確 愿意且有效指導(dǎo)同事 與病人之溝通 與照顧者家屬溝通 尊重病人的隱私 與同事之語(yǔ)言溝通 與同事之文字溝通

10、能他人之貢獻(xiàn)與價(jià)值 可得性及可信性,Portfolio/ passport,Portfolio學(xué)習(xí)歷程 Passport學(xué)習(xí)護(hù)照 Procedure, Operative or Case Logs 由學(xué)員匯集各項(xiàng)學(xué)習(xí)的證明及成果,31,Standardized oral Examination,使用18-60個(gè)真實(shí)病例做表現(xiàn)評(píng)估 考問(wèn)老師必須先接受過(guò)口試訓(xùn)練 考問(wèn)老師先陳述一個(gè)病例再提出臨床考題 每一病例的考問(wèn)時(shí)間為3-5分鐘,32,Paper-based test,Written examination Multiple choice questions (MCQs) Short essay

11、 Psychometric qualities/ Construct validity Formative/ summative Quiz/ national licensing examination,33,臨床能力評(píng)量的回饋,澄清、提示重點(diǎn)、促進(jìn)改善,34,臨床教師須予適當(dāng)回饋之處,面談技巧Medical Interviewing Skills 身體檢查Physical examination skills 咨商技巧Counseling Skills 臨床判斷Clinical Judgment 專(zhuān)業(yè)素養(yǎng)Humanistic Qualities/ Professionalism 組織能力及效率Organization/ Efficiency 整體表現(xiàn)Overall Clinical Competence,35,臨床教育進(jìn)行回饋的五大步驟,Get a commitment (a plan):設(shè)定教學(xué)目標(biāo) 讓學(xué)員先抒發(fā)己見(jiàn),了解學(xué)習(xí)需求,設(shè)定教學(xué)目標(biāo) Probe for supporting evidence:探索證據(jù)支持 透過(guò)開(kāi)放式的問(wèn)題,了解學(xué)員的思路 Teach general rules:教導(dǎo)一般性原則 原則性教學(xué),訓(xùn)練分析思考能力 Re