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1、12009/4/231床能評方法與回饋技巧床能評方法與回饋技巧中國醫藥大學附設醫院急診部 王中邦醫師中國醫藥大學附設醫院急診部 王中邦醫師E-mail: .tw Phone: 0966202713醫院評鑑暨醫品質策進會急診醫學實務教師培訓營2009/4/232課程內容課程內容?瞭解醫學教育中評的原則及使用的評 工具?討常用評工具的優點與限制?介紹床教育中回饋的概及其重要性?學習有效/有建設性回饋的原則與技巧22009/4/233評引導學習評引導學習?“Assessment Drives Learning” by George E. Miller (1919-1998)2009/4/234畢業後
2、醫學教育的趨勢畢業後醫學教育的趨勢?以核心能為導向的訓 Competence-based training?以訓成效作為評及評鑑重要依據 Outcome-based assessment and accreditationCompetence-based = Outcome-based32009/4/235能能(competence)的定義的定義?“the habitual and judicious use of communication, knowledge, technical skills, clinical reasoning, emotions, values, and refl
3、ection in daily practice for the benefit of the individuals and communities being served”by Epstein 356:387-96)2009/4/236畢業後醫學教育要求之核心能畢業後醫學教育要求之核心能?ACGME: Outcome project, 2001 美國畢業後醫學教育評鑑委員會(Accreditation Council for Graduate Medical Education)?IOM: Five competences, 2003 美國醫學研究院(Institute of Medic
4、ine)?GMC: Foundation training, 2005 英國一般醫學評鑑委員會(General Medical Council)42009/4/237Six interrelated domains of competence-ACGME?Medical knowledge?Patient care?Professionalism?Communication and interpersonal skills?Practiced-based learning and improvement?Systems-based practice2009/4/238醫人員五項核心能醫人員五項
5、核心能-Institute of Medicine?提供以病人為中心的醫; Provide patient-centered care?在醫團隊中工作 Work in interdisciplinary teams?基於證據執專業; Employ evidence-based practice?應用品質改善; Apply quality improvement?資訊的用; Utilize informatics52009/4/239評的三大目標評的三大目標?To optimize the capabilities of all learners and practitioners by pro
6、viding motivation and direction for future learning?To protect the public by indentifying incompetent physicians?To provide a basis for choosing applicants for advanced training2009/4/2310各害關係人如何看待評各害關係人如何看待評62009/4/2311ACGME-Outcome project?目標：增進和改善畢業後醫學教育品質?過去：評訓計畫著重結構(structure) 和過 程 (process)，評鑑
7、焦點在於“ a programs potential to educate”?未：評兼顧結構和過程，注重訓計畫 達到真正的成果(outcomes)，評鑑焦點在於“ a programs actual accomplishments”2009/4/2312常用評工具分常用評工具分?Written exercisesMCQ, short-answer questions, structured essays?Assessments by supervising cliniciansGlobal ratings with comments at end of rotation, Mini-CEX,
8、oral exam., CbD /CSR, DOPS?Clinical simulationsStandardized patients, OSCE, screen-based / high- technology simulation, DOPS?Multisource (“360-degree”) assessmentsPeer /patient assessments, self-assessments, portfolios72009/4/2313The Foundation Program assessment tools, GMC?案討 Case based discussion,
9、 CbD?直接觀察學員床實際操作 Mini clinical evaluation exercise, mini-CEX Direct observation of procedural skills, DOPS?多源回饋 Multi-source feedback, MSF2009/4/2314同層次的評同層次的評?Medical record audits?Diary, Logbook, Passport?Direct observation (Mini- CEX, OSCE/SP)?Model, Patient simulator?Case presentation?Computeriz
10、ed patient simulation Exam.?Oral Exam.?Essay question?Multiple choice questionDOESFramework of AssessmentKNOWSSHOWS HOWKNOWS HOWGeorge E. Miller: Acad Med 1990BehaviorCognition82009/4/2315床能評工具分之一床能評工具分之一 Written exercises?Multiple-choice questions (MCQ)-knowledge, clinical reasoning, problem-solvin
11、g ability, ability to apply knowledge- summative assessments; national licensing/ certification exam. - assess many content areas in relative little time, high reliability, can be graded by computer?Short-answer questions?Structured essays2009/4/2316床能評工具分之二床能評工具分之二 Assessments by supervising clinic
12、ians?Global ratings with comments at end of rotation?Mini-Clinical Evaluation Exercise (Mini-CEX)?Direct Observation of Procedural Skills (DOPS)?Case-based Discussion (CbD) / Chart Simulated Recall (CSR) oral exam.?Oral examination92009/4/2317床能評工具分之三床能評工具分之三 Clinical simulations?Standardized patien
13、ts (SPs)?Objective Structured Clinical Examination (OSCE)?Screen-based / high-fidelity (high- technology simulation2009/4/2318床能評工具分之四床能評工具分之四?Multi-source (360-degree) assessments?Peer assessments (peer assessment tool, PAT)?Patient assessments ?Self-assessments?Portfolios (e-porfolios) / Passport1
14、02009/4/2319Mini-CEX 迷你床演評迷你床演評?ABIM發展推薦的評工具(American Board of Internal Medicine)?可性很高，教師學員皆認同Norcini JJ, et al. Ann Med 1995?於21所醫院進前導研究，頗獲好評Norcini JJ, et al. Ann Med 2003?信效優於傳統評方法Duming SJ, et al. Acad Med 2002?可適用於醫學生Hauer KE. Acad Med 2000 SPs)的觀?於1975，由Harden等人所提出?事先編寫出結構式的床測驗項目?對學員解及示範之後?以受過
15、訓的演員扮演病患（標準化病人）?讓學員進病史詢問及身體檢查?指導教師則在旁評，依實際操作的結果，依照 OSCE核對表，給予學員適當的評分162009/4/2331?History taking?Physical examination?Simple procedures?Data interpretation ?Patient management problems?Communication?AttitudeOSCE 評估床能評估床能2009/4/2332?是評估床醫學知、技能和態的方法?評估筆試無法做到的部分?至少10站，每站focused on a different task?2004
16、美國醫師考試已採用標準病人?動員龐大、耗時、花費大OSCE172009/4/2333Available Simulation Equipment?Standardized Patients?Improvised Technology?Screen (PC) Based Simulation (DxR, MicroSim) ?Partial Task Trainers?Low/Med/High Fidelity Mannequins?Virtual Reality 2009/4/2334Simulation is the best, second best Tool for Assessing?ACGME Toolbox of Assess
