迷你臨床演練評量(mini-CEX)於護理領域之運用

The Application of the mini-CEX in Nursing

護理教學需要以臨床情境為主軸，協助學生將理論運用於實務，進而培養其職場所需的技能。「迷你臨床演練評量」（mini clinical evaluation exercise, 簡稱mini-CEX）於2005年由美國引進台灣，由醫學領域推展至護理領域，現已成為醫事人員臨床技能的評量與教學工具。mini-CEX的相關文獻多見於醫學教育領域，護理領域仍較稀少。mini-CEX的優點為真實性與便利性，可反應學員的臨床表現，並透過教師的立即回饋，促進臨床技能的成長，但成效可能依情境及評值者的經驗背景而異，故教學價值高於評量價值。而工具的缺點包括持續和穩定度欠佳、評量者間存在變異性、不易運用於複雜和特殊性患者，且非每一種臨床技能的評量都適用。雖然工具的效度和鑑別度已獲得諸多肯定，然而評量者間的一致性仍有待提升。建議護理領域可依據護理核心能力，建立合適的評量項目與行為指標，例如採用1-9分的評分範圍，以鑑別臨床能力的差異，進而測試修正後的評量表於護生、各單位護理人員之適用性，持續提升標準化工具的信效度，並以舉辦工作坊和教育訓練加強評量者間的一致性和穩定度。

Nursing education should be based on the clinical situation in order to help students apply the theory into practice, and develop the required skills in workplace. The mini-Clinical Evaluation Exercise (mini-CEX) was introduced to Taiwan from the United States in 2005. It was extended to the nursing field from the medical field and had become an assessment and teaching tool for clinical medical professionals. The related literature of the mini-CEX is common in the field of medical education, but still scarce in nursing. The advantages of the mini-CEX are authenticity and convenience. It can show the trainees’ clinical performance and promote their growth of clinical skills through raters’ immediate feedbacks. However, the effectiveness of the mini-CEX application may vary by the clinical situation and by the rater’s clinical experience and background, so its teaching value is higher than the assessment value. The weak points of the mini-CEX include poor continuity and stability, existing variability between raters, difficulties in applying to complex and special patients, and limited application to every clinical skill. Although the validity and reliability of the mini-CEX have been supported by many researchers, the consistency of the inter-raters has yet to be improved. It is recommended that establishing the appropriate assessment items and behavioral indicators based on the nursing core competencies, such as the use of 1-9 points score to identify the differences in clinical competence, and then test the applicability of the refined tool for nursing students and clinical nurses in different units, continuously enhancing the reliability and validity of the standardized tool, and organizing the training workshops to strengthen the consistency and stability among raters.