建構及檢測護理客觀結構式臨床技能測驗考題之信效度、鑑別度及難易度

The Establishment and Examination of the Reliability, Validity, Discrimination, and Difficulty of Nursing Objective Structured Clinical Examination (OSCE)

背景：客觀結構式臨床技能測驗（objective structured clinical examination, OSCE）是目前評估護理學生專業臨床能力的方式之ㄧ，其標準化流程之考題發展與考題信效度檢測值得關注。目的：本研究旨在，依標準化流程建構護理OSCE考站；分析OSCE考站專家效度及預測效度、評分者間一致性、內在一致性、考題相關性、鑑別度與難易度。方法 以描述性、橫斷式研究設計，自2015年9月至2016年10月依測驗藍圖發展8站式OSCE考試，應用於北部某科技大學207位四技四年級臨床選習前的護理系學生，並且測試OSCE考題的信效度、鑑別度與難易度。結果 本研究共建構8站OSCE考題， 各題的專家效度指標為.85–1.0， 評分者間一致性為.80–1.0， Cronbach’s alpha為.53–.82，考題相關性為.36–.63，鑑別度多為優良或非常優良，難易度多為容易到適中，且OSCE成績對臨床選習成績具良好的預測效度。結論／ 實務應用：透過標準化的考題建置流程，發展的8站式護理OSCE考題具良好的信效度、難易度適中及良好的鑑別度，並可做為檢測學生最後一哩專業技能的方法，期許本研究的結果提供護理教育者於發展OSCE評量之參考。

Background: The objective structured clinical examination (OSCE) is one of the evaluation strategies used to examine the clinical competence of nursing students. More attention needs to be paid to establishing an examination that is based on the standardized protocol and on reliability and validity. Purposes: The aims of this study were to develop an OSCE that is based on a standardized protocol and to analyze the content validity and predictive validity, inter-rater consistency, internal consistency, item-to-total correlation, and the degree of discrimination and difficulty of this OSCE. Methods: Based on the blueprint for OSCEs that use an 8-station format, this study used a descriptive, cross-sectional design and a sample population of 207 senior students who were preparing for their last-mile practicum at a nursing technology university in northern Taiwan. The study period lasted from September 2015 to October 2016. Furthermore, the validity, reliability, degree of discrimination, and difficulty of the OSCE were examined. Results: An OSCE with an eight-station format was developed. The content validity index (CVI) was .85–1.0, inter-rater reliability was .80–1.0, Cronbach’ alpha internal consistency was .53–.82, and item-to-total correlation was .36–.63. In addition, the level of difficulty of the OSCE was easy to moderate and the discrimination of the OSCE ranged from fair to excellent. Meanwhile, the OSCE scores of the participants appeared to be a valid predictor of scores on the last mile practicum. Conclusion/Implications for Practice: According to the standardized protocol of OSCE development, an 8- station nursing OSCE format is reliable and valid, providing fair levels of difficulty and discrimination. The developed OSCE may be applied to evaluate the clinical competence of nursing students prior to beginning their last mile practicum. The results from the present study may provide a reference for nursing educators who are responsible for developing OSCE evaluation strategies.