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題 名 | 臨床技能測驗成為我國醫師證照考試項目之關鍵問題=Some Key Issues Concerning the Introduction of Clinical Skill Test as a Subject in the National Medical Licensing Examination |
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作 者 | 高明見; | 書刊名 | 國家菁英 |
卷 期 | 6:4=24 2010.12[民99.12] |
頁 次 | 頁107-126 |
分類號 | 573.448 |
關鍵詞 | 客觀結構式臨床技能測驗; 醫師國家考試; 評分人員; 標準化病人; 考試及格標準; OSCE; National medical licensing examination; Rater; Standardized patient; Standard setting; |
語 文 | 中文(Chinese) |
中文摘要 | 我國醫師證照考試,至今仍僅採傳統紙筆測驗方式,並且只採選擇式測驗題型,其考試及格醫師,偏重記憶性醫學知識,缺乏臨床技術與醫病溝通的核心職能,難以因應醫療科技的快速發展以及符合民眾對醫療品質與健康照護的要求。 目前先進國家,都先後將臨床技能的測驗,即所謂的高階客觀結構式臨床測驗(High-Stakes Objective Structured Clinical Examination, OSCE)納為醫師資格認證的考試項目之一。考選部自民國98年規劃醫學院畢業生,自民國101年開始必須通過高階OSCE測驗取得及格證書,方能報考醫師國考第二試。預計如果該方案順利實施,將於未來考慮將此高階OSCE納為醫師國考考試項目之一。因此全國各醫學院與醫學中心,均積極改進醫學教學方式並設立臨床技能中心,除充實考場硬體的設備外,更加強考試軟體的建置,尤其是標準化病人(Standardized Patients, SP)之招募與培訓,以推動與實施此種測驗,從低年級的醫學生養成式的Formative OSCE到畢業前總結式的Summative OSCE。 筆者有幸與考選部此項業務有關人員與台灣醫學教育學會的OSCE小組委員,實地訪視全國11所醫學院與3家醫學中心的臨床技能中心,與其運用該中心實際進行OSCE測驗與評估的情形與成效。 筆者以為要將高階OSCE 納為國家醫師考試的項目之一,實為我國國考制度的一項重大改革,除了考選部須積極規劃編列充足的財源與人力外,有些關鍵問題仍須深入探討,諸如評分人員(考官)與標準化病人的遴選培訓、認證與整合協調問題,以及OSCE考試及格標準的設定,這些包括有效減少評分人員間(intra-rater & inter-rater)的評分誤差與加強標準化病人的培訓以達逼真且正確一致性的模擬扮演,以及慎重設定考試及格標準,以確保OSCE測驗品質。倘以後將其納為醫師國考的考試項目,則其篩選及格的醫師,才能成為具備核心職能的稱職醫師,為國民健康把關,並與國際趨勢接軌。 |
英文摘要 | The Objective Structured Clinical Examination (OSCE) is a commonly used evaluation tool of high reliability to assess clinical competence of medical students and physicians. Lately OSCE examination has become a part of medical licensing examination in Canada , USA and many other countries. However, so far our National Medical Licensing Examination has traditionally only included the written examination with multiple-choice questions. In order to ensure competence of a licensed physician for performing medical practice of good qualities, the Ministry of Examination in 2009 proposed that qualification of high-stakes OSCE will be required as a prerequisite to sit for part 2 of the National Medical Licensing Examination. The implementation of OSCE was actively carried out in each medical college and medical center under the supervision of the Taiwan Association of Medical Education this year. Before the application of high-stakes OSCE in the National Medical Licensing Examination, further investigation on certain key issues is needed to ensure the quality (reliability and validity) of an OSCE. These issues include quality control of the raters and standardized patients, as well as the method of standard setting. The inter-rater variability in assessment should be effectively and substantially reduced. The consistency of standard clinical simulation of individual standardized patient should be strictly enforced and assured. The method of standard setting should be carefully evaluated and determined. With these precaution and enhancement, the quality of an OSCE would be better assured, thereby, justifying OSCE to be applied in the National Medical Licensing Examination. Subsequently, the qualified physicians will be more competent for carrying on good medical practice. |
本系統中英文摘要資訊取自各篇刊載內容。