應用迷你臨床演練評量于實習醫學生的評量結果

葉建宏; 邱浩彰; 周定遠

doi:10.6145/jme.200806_12(2).0003

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P77 - 83

医药卫生 > 医药总论
社会科学 > 教育学

DOI： 10.6145/jme

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应用迷你临床演练评量于实习医学生的评量结果

Implementation of the Mini-CEX during the Clerkship Part of Medical Training

叶建宏(Jiann-Horng Yeh) ；邱浩彰(Hou-Chang Chiu) ；周定远(Ting-Ywan Chou)

Journal of Medical Education ； 12 卷 2 期 (2008 / 06 / 01) ， P77 - 83

繁体中文 DOI： 10.6145/jme.200806_12(2).0003

迷你临床演练评量；立即回馈；实习医学生；月晕效应； mini Clinical Evaluation Exercise ； immediate feedback ； clerkship ； halo effect

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摘要 │ 参考文献 (17) │ 被引用文献 (2) │ 国际计量

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Currently, the mini Clinical Evaluation Exercise (mini-CEX) is a well-developed tool that is used to evaluate clinical skills. Most reported studies have described its application for the rating of residents. There have been limited reports on the use of the mini-CEX as part of the clerkship curriculum. We had implemented four mini-CEX ratings per year in our 2-year clerkship since November 2006 at the College of Medicine, Fu-Jen Catholic University. Up to January 2008, we had collected 68 rating sheets including 39 ratings related to the medical specialty and 29 related to the surgical specialty. Seventy nine percent of the mini-CEX ratings had happened on the ward. The mean duration of direction observation was 19.1 minutes and the mean duration of immediate feedback was 15.6 minutes. Interestingly, the mean durations of direct observation and feedback were significantly longer in a non-ward setting, either the outpatient clinic or the emergency department. The encounters in the surgical specialty spent more time on both direct observation (p=0.0357) and feedback (p=0.0288) compared to the assessments in the medical specialty. The mean score for overall competency over the 68 ratings was 5.9. Across all seven domains, no significant differences could be found. The score in the physical examination domain was the lowest and that in the medical interview domain was the highest. There was no statistically significant difference between the scores for the medical and surgical specialties. Forty-six written feedbacks (68%) were classified as good feedback. Twelve (18%) were found to suffer from a suspected halo effect. This effect was closely associated with a poor written feedback based on the fact that there was a higher proportion of suspected halo effect among those ratings with poor written feedback (7/22, 32%) comparing to those with good feedback (5/46, 11%) (p=0.0404). In summary, the implementation of the mini-CEX as part of clerkship was feasible and practical based on this first study using mini-CEX rating as part of the clerkship curriculum in Taiwan. In addition to the traditional medical specialties, the surgical specialty was also suitable for mini-CEX evaluation. Comparing our experience of the mini-CEX rating here with that during residency, we found that there were higher scores and longer feedback times during clerkship mini-CEX rating. Regarding the ratings themselves, the presence of the halo effect and poor written feedback implies that a continuous faculty training program is warranted in order to improve the quality of the mini-CEX ratings.

参考文献 ( 17 ) 〈TOP〉

陈伟德、林正介、黄秋锦(2006)。建置迷你临床演练评量（mini-CEX）之经验与试办成果。医学教育，10，232-239。
连结：
陈伟德、林正介、黄秋锦(2006)。建置迷你临床演练评量（mini-CEX）之经验与试办成果。医学教育，10，232-239。
连结：
陈伟德、蔡长海、黄崑岩(2005)。临床医学教育与Mini-CEX。医学教育，9，74-81。
连结：
叶建宏、邱浩彰、邹国英(2007)。迷你临床演练评量之效度研究—辅医经验。医学教育，11，39-46。
连结：
Durning SJ,Cation LJ,Markert RJ(2002).Assessing the reliability and validity of the mini-clinical evaluation exercise for internal medicine residency training.Acad Med,77,900-904.

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