以系列OSCE實地測驗之訓練模式協助實習醫學生準備參加台灣首次OSCE國家考試

Training through Serial OSCEs for Medical Students Facing Start of Taiwan National OSCE

背景和目的：缺乏OSCE經驗的學員可能會成為低分族群。本研究透過單一教學醫院OSCE考場進行之五次OSCE成績分析驗證融入四次OSCE實地測驗之臨床技能訓練計畫之教學成效。方法：2013年全國醫學校院OSCE聯合測驗在本院的OSCE考場參加的考生依所屬醫學院校不同OSCE經驗值可分為ABCD四組共計34人；A組為A 醫學院實習生9名(Group A)，B組為B醫學院實習生10名(GroupB)，C組為外國醫學院畢業生在本院接受實習訓練8名(Group C)，D組為非在本院實習而由台灣醫學教育學會OSCE辦公室委託代考D醫學院學生7名(Group D)。四組學生在醫學院學程中OSCE經驗分別為：A組8次、B組1次，C組中六名沒有OSCE經驗者為Cf組(Group Cf)，D組1次，但對本院醫療常規及考場皆不熟悉。本院在學年度中一共舉辦五次OSCE，前四次為模擬考，第五次為2013年全國聯測，本研究紀錄每一次考試成績並加以分析。結果：Group Cf組同學前三次平均測驗成績明顯低於Group A，但與Group B無顯著差異；第四、五次各組的平均測驗成績中，Group Cf則與Group A及Group B無顯著差異。Group D組同學在第四次測驗成績顯著低於Group A, B, C及 Cf，但在第五次的OSCE之平均測驗成績則與其他組別無顯著差異。結論：教學醫院的臨床技能訓練計畫應包含合理次數的OSCE模擬考試以幫助缺乏OSCE經驗同學熟悉OSCE的考試方式。對於非不熟悉醫院考場環境之考生，OSCE考場應提供充分的環境及常規介紹，或藉由舉辦OSCE模擬考試，使考生充分熟悉OSCE考場，確保考試的公平性。

Background & Purpose: Students without experience in the Objective Structured Clinical Examination (OSCE) may comprise a special low-score group. This study analyzes the scores of five OSCEs to verify this assumption. Methods: Four groups comprising 34 students from various medical schools with varying OSCE experience participated in five OSCE tests held in the examination room at our hospital, including the 2013 National Joint OSCE as the fifth test. For this study, we recorded the scores of each examination for analysis. Results: The mean scores of group Cf for the first three exams were markedly lower than those of group A, but did not differ considerably from those of group B. Regarding the mean scores of the fourth and fifth exams, group Cf exhibited no marked difference from groups A and B. The group D scores for the fourth exam were substantially lower than those of groups A, B, C, and Cf. However, the mean score of Group D for the fifth exam did not differ markedly from those of the other groups. Conclusions: To ensure an unbiased examination, the training plan of a teaching hospital should include an appropriate number of OSCE practice examinations to familiarize the students with the examination methods. Thus, for students who are unfamiliar with the examination methods, a sufficient introduction to the environment is warranted, which may include practice exams.