張美惠2006-07-262018-07-112006-07-262018-07-112004http://ntur.lib.ntu.edu.tw//handle/246246/22901臨床醫學教育的目標，在培養醫 師能有效發揮醫療技能，滿足病人及 社會的需求，創造高品質的醫療環 境。醫學生的基本臨床技巧，包括醫 病關係、病史詢問、理學檢查、以及 臨床推理（臨床問題解決）等，則為 臨床醫學教育的基本教學項目。進年 來由於高科技檢查的進步和整體醫療 環境的影響，醫療照顧逐漸轉向以檢 查為主，臨床技巧教學常常被忽略。 加上傳統的臨床醫學教育的評量方式 以紙筆測驗為主，偏重記憶、缺乏思 考、與臨床脫節，輔以指導教師短暫 片面的臨床觀察，缺乏完整客觀的標 準。造成醫學教育的扭曲，醫學生錯 誤的學習動機、態度和方向。臨床能 力的評量即是針對各項臨床技能的評 量，是一種以實際表現為基礎的評量 方式，評量結果除了要能反映出受試 者的不同程度外，還要能夠反映出學 習缺失，而能提供導正機會，幫助指 引受試者往後的學習，並達到實際操 作練習的效果。主題結構化臨床測驗 使用標準病人，是一種「以實際表現 為基礎的測驗」，研究證實能夠了解醫 學生的學習能力、客觀地進行評量、 並給予醫學生適當的回饋，是目前公 認最能達到有效評量的方式。本研究 的研究對象是醫學系五年級學生與臨 床小兒科教師，以多重測驗站的「以 實際表現為基礎」整合型測驗模式為 方法：包括有臨床實例命題(個案敘述 型式、多媒體型式)，主題結構化(群組) 臨床測驗。 第一年研究的目的在探討適合醫 學生和老師的測驗模式、醫學生的基 本臨床技巧學習狀況及缺失，進而了 解個案設計、評量項目設計的適當內 容，迄今已進行11 組同學的整合型測 驗模式，回收230 份問卷，建立題庫： 個案敘述型式、多媒體型式，主題結 構化群組臨床測驗10 題。學期結束 後，針對93 學年度回收之121 份有效 問卷進行問卷統計，發現對「主題結 構化臨床測驗的準備方式」是平時多 接觸病人(63.6%)、看教科書 (68.6%)，看共同筆記的比率下降至 43%。這與一般性考題的準備方式：多 接觸病人(18%)、看教科書(68.4%)， 看共同筆記的(57.9%)明顯不同，這證 明本研究的目的：利用測驗方式的改 變，改善學生學習的方式，增加接觸 病人的時間，加強基本臨床技巧的練 習。The goals of medical education are to cultivate physicians capable of applying their medical skills to meet the needs of the patients and society, and to create a high quality medical care environment. Basic clinical skills, including history taking, physical examination, patient interaction, logic thinking and clinical management are considered as key elements in medical practice. But traditional clinical medicine teaching methods are lectures and bedside teaching. Traditional clinical performance assessments are given by paper examination and a little information over a short period of observation time. The traditional assessment methods have limited competency in assessing students’ clinical ability and capacity and distort the students’ motivation and attitudes for learning. So teaching medical student of basic clinical skill has long time been ignored. Very few courses on clinical skills are offered. Both teachers and students do not pay much attention in learning and implementing basic clinical skills. The situation has changed. Clinical performance examination using Objective Structured Clinical Examination (OSCE) has become the most popular method in teaching and evaluating clinical performance of medical students. This study includes 5th year medical students and clinical pediatric teachers in a multiple station performance assessment including Group Objective Structured Clinical Examination (GOSCE), OSCE, multimedia test, case study test (patient management problems) and traditional paper test.. The study can 1. emphasize the importance of basic clinical skills in patient care. 2. help to evaluate individual student’s clinical performance in patient contact. 3. provide timely personalized feedback and detailed performance report to improve student learning. 4. provide information to clinical teachers how teaching strategy should be revised for better results. 5. develop the GOSCE and OSCE model in the pediatric background. 6. facilitate a patient centered care model for better care quality.application/pdf67793 bytesapplication/pdfzh-TW國立臺灣大學醫學院小兒科醫學教育主題結構化群組臨床測驗medical educationgroup objective structured clinical examinationreporthttp://ntur.lib.ntu.edu.tw/bitstream/246246/22901/1/922516S002003.pdf