客觀結構式臨床測試於護理教育之應用

The Applications of Objective Structured Clinical Examination in Nursing Education

客觀結構式臨床測試(Objective Structured Clinical Examination, OSCE)自1975年開始使用於評量醫學生的臨床技術及能力後，也廣泛應用於健康照護專業，包括護理。本文透過一些文獻的回顧，陳述OSCE在護理教育上的發展，也討論一些OSCE應用於評估護理學生時重要的議題，包括需要更完善的硬體軟體規劃，當設計新的OSCE考題時，需要與評量目的相吻合，且須經過前趨測試；對於評分表和及格標準的審議、考試時間的安排、考站的規劃、標準化病人的培訓，以及成果評量都需要互相配合，才能增加該OSCE結果的信效度。結論是OSCE用於評價護理學生的臨床能力已成為非常重要及優良的方法，但若單一使用於評量其臨床能力時，則需要非常謹慎，必須確認是否符合能測出預期測量的目標。本文希望可以作為一個基礎，提供相關護理教育體系進行OSCE之參考，共同合作以提供護理學生更佳之學習及評量效果。

Developed in 1975, the Objective Structured Clinical Examination (OSCE), was an examination that originally designed to evaluate medical students’ clinical competencies. It has been adapted and applied to other disciplines in health care such as nursing. This narrative review article briefly describes the historical developments of OSCE in nursing education as well as the current applications in the evaluations of nursing students. Several key elements for a successful implementation of the OSCE in nursing were identified which include a careful design of the OSCE and proper changes of students’ performances after the test. In the OSCE, several OSCE stations are designed in advance with a small scenario in each station to measure students’ responses, nursing or critical thinking skills, planning or patient instructions. For the OSCE to be successful, competencies should be tailored to meet with student’s expected level. When a new OSCE is designed, researchers recommend matching students’ competencies with their grade level and pre-test its accuracy before the exam day. In addition, for the OSCE results to be reliable, grading system, passing point, time frame allowed for the test, classroom arrangement, faculty and student ratio and standardized patient’s responses should be planned in advance.
In conclusion, the OSCE is a very important tool that is widely used in the evaluation of nursing students. However, it needs to be use with caution. Accuracy to the competency that was measured needs to be evaluated. We hope this article can provide some information for further development in nursing curricular.