以客觀結構臨床測驗評估中醫實習醫學生中醫實習之學習成效

Use of An Objective Structured Clinical Exam (OSCE) for Evaluating the Learning Effectiveness in the Clinical Internship of Chinese Medical Students

背景：利用客觀結構臨床測驗對中醫實習醫學生進行臨床能力評估，了解實習的學習成效。對象與方法：收案對象為2017年6月至2018年5月進行實習之中醫醫學生42位。利用前後測分數差異來評估實習之學習成效。前後測皆為6站。結果：後測之總成績有明顯進步（366.7±39.6 VS 396.7±48.9），以科別來說，中醫婦科、中醫內科、中醫傷科後測成績較前測成績高（48.1±12.2 VS 70.9±11.1, 50.9±18.1 VS 66.6±10.7, 45.6±18.7 VS 57.9±14.1）。然而，中醫兒科後測成績則明顯退步（64.8±10.3 VS 51.8±10.5）。以面向來看，中醫四診與臨床技能操作後測成績顯著進步。結論：整體而言，經過一年實習後，中醫實習醫學生有不錯的學習效果，但在病史詢問方面仍有進步空間。此結果可供臨床教師作為教學課程改進之參考。 Background: Based on the guidance in Chinese Medicine Clinical Skills Assessment Model and Clinical Teaching Practice Training Program, supported by the Ministry of Health and Welfare, we conducted the objective structured clinical examination (OSCE) to evaluate the learning effectiveness in the clinical internship for the fifth-year traditional Chinese medical (TCM) students. Subjects and methods: A total of 42 Chinese medical students were enrolled in the study during July, 2017 to May, 2018. A pretest-posttest design was employed by this study. Participants were evaluated by the OSCE before and after the 1 year clinical practice with 6 assessments of clinical skills. Results: The total score of posttest was significantly higher than that of pretest (366.7±39.6 VS 396.7±48.9, P＜0.001). In term of subjects, the score at the posttest were higher than at the pretest, as the internal medicine of TCM (50.9±18.1 VS 66.6±10.7, P＜0.0001), the gynecology of TCM (48.1±12.2 VS 70.9±11.1, P＜0.0001) and the traumatology of TCM (45.6±18.7 VS 57.9±14.1, P=0.001). Notably, the score of the pediatrics of TCM at the posttest declined significantly than at the pretest (64.8±10.3 VS 51.8±10.5, P＜0.0001). In terms of dimensions, the ability of the four diagnostic methods and the clinical skills of TCM improved among the TCM students after the clinical practice training. Conclusions: To conclude, the TCM students made the progress in clinical competency after 1-year clinical internship, but there is a suggestion on improving the ability for the patient's history taking. The result could provide the information for the clinical preceptors on the modification of teaching program.