從實證觀點談OSCE於護理教育之應用

The Implication of Objective Structured Clinical Examination in Nursing Education : An Evidence-based Appropach

隨著國內人口老化及疾病型態的轉變，國人對醫療照護多元化及品質之需求均增加，護理人員應思考如何於此複雜化之健康照護體系展現專業之角色及功能。考量護理是「以能力為導向之實作專業」，護理教育者須透過以能力為導向之課程設計及客觀的評估方法，評量學生的專業知識、技能及態度，以培育兼備臨床及理論能力且符合實務需求之護理學生，本文以實證觀點探討建構及評價客觀結構式臨床技能測驗（objective structured clinical examination, OSCE）於護理教育之應用，包括OSCE發展沿革及應用、標準化考題建構、考生準備、考官及標準病人訓練，OSCE考題之信效度、難易度及鑑別度檢定方法及判讀。另外，為了讓OSCE達到護理教育最大的教學及評量效益，建議發展學生準備的評估工具、發展長站型或整合型考題、建構E化評分系統、檢定合適考站數目。本文提供護理學校與醫療機構考慮採用OSCE教學評量之參考，日後更能以標準化及實證化方式規劃及執行護理OSCE。

Due to the increased number of aging population and changing disease pattern, there are increases in demand for multidisciplinary care and quality care. Nurses are expected to perform their roles and functions within a complicated health care system. Also, considering nursing as a competence-based practice profession, nursing educators need to develop competence-based curriculum and objective evaluation of students' knowledge, psychomotor, and attitude, thereby enhancing students' clinical & theoretical competencies and fitness for practice. The purpose of this article was to describe the construction and evaluation of objective structured clinical examination (OSCE) in nursing education from an evidence-based perspective. This included the development and implication of OSCE, standardized examination construction, preparation of examinees, training of evaluator and standardized patient, analyses and interpretations of reliability, validity, difficulty, and discrimination of OSCE. In addition, the authors suggested developing related evaluation tools for the preparation of examinees, long and/or integrated station, OSCE management information system, and the appropriateness of station numbers to strengthen the OSCE efficacy in teaching and evaluation. This article provided nursing schools and medical institutions with essential information for planning and implementing OSCE from a standardized and evidence-based approach in the future.