| 摘要: | 迷你臨床演練評量(mini-CEX) 藉著臨床教師直接觀察醫學生或住院醫師與病人之互動，依醫療面談、身體檢查、人道專業、臨床判斷、諮詢建議、組織效能及整體評量七項指標給予評量及回饋，已在多國實施，本文介紹在台灣建置mini-CEX 之經驗，並報告工作坊及試辦之結果。經由印製中文版評量手冊，訓練種子教師，以及舉辦三場工作坊：藉著簡報講解、錄影帶研習、分組討論及錄影帶模擬評量等方式，訓練臨床教師及醫學生後，開始進行試辦。工作坊共訓練389 名師生，參與者大多能理解實施方式及評量項目，錄影帶模擬評量亦顯示參與者能分辨診療行為之優劣。試辦期共執行了115 次mini-CEX，分別由主治醫師或住院醫師擔任教師，平均執行時間不到30 分鐘。mini-CEX 的評量項目與學習目標相符，信效度已經國外證實，能同時有量化及敘述性的資料，可行性極高，僅需加強師生的訓練以正確的執行，應該可以補足目前臨床教學缺少直接觀察的缺陷，達成多元評量的目的。
Mini-CEX (Clinical Evaluation Exercise) is being implemented in many countries by direct observes the encounter between medical student or resident and the patient. The evaluator rates the student's performance in accordance withthe seven items: medical interviewing skills, physical examination skills, humanistic qualities/professionalism, clinical judgment, counseling skills, organization/efficiency, and overall clinical competence, and provides feedback. This paper aim to describe the experience of implementing mini-CEX in Taiwan and to present the results from training workshop and pilot study. Via printing the Chinese edition mini-CEX booklet, training core teachers, and holding three workshops, which include introductional presentation, video-tape exercise, small group discussing, and a mock test with another video-tape, a pilot study was started after the clinical teachers and intern student learned the use of mini-CEX. A total of 389 participants was trained in workshops. Most participants can understand the method of mini-CEX and it's evaluation items after workshop. The results of mock test also show participants can distinguish the quality levels of performance during the patient/doctor encounter. During the pilot study, 115 mini-CEX were carried out. The attending doctor or the resident serve as a rater for intern student and the average execution time is less than 30 minutes. Popularizing mini-CEX is recommended because it fulfill the following specific criteria for the clinical assessment: (1) there should be multiple assessments by multiple observers using multiple tools at multiple time points, (2) the tools should be reliable, reproducible, and valid; (3) the tools must be practical (i.e., feasible, convenient, low time commitment, easy to use, and inexpensive to implement and maintain); (4) the tools must produce qualitative and quantitative data; (5) the assessment process must be linked to learning objectives; and (6) the grading scale should be open and clearly defined. By strengthening the training of raters to execute un-biaslly, mini-CEX can make up the deficiency of few direct obervation in current clinical teaching. |
