以標準病人評估實習醫學生於急診醫學之臨床能力

Evaluating the Clinical Competence of Emergency Medicine Interns Using Standardized Patients

10.6145/jme.200703_11(1).0004

張博彥(Bor-Yann Chang)；謝正源(Jane Yane Shieh)；王如娥(Ju-O Carol Wang)；沈振庭(Michael J Sheen)；高森永(Sen-Yeong Kao)；張聖原(Sun Yran Chang)；何善台(Shung-Tai Ho)

臨床能力 ； 標準病人 ； clinical competence ； standardized patient

Journal of Medical Education

11卷1期（2007 / 03 / 01）

27 - 38

繁體中文

客觀的臨床技能評估是改善臨床能力的重要方法。考量急症處理能力的培養應為醫學生所具備，故於2004 年進行急診醫學之標準病人訓練及評估模式之建立。本次共設計八種急診常見疾病之案例，並以實際診間安排臨床情境讓學生與標準病人互動，從而評估學生之臨床能力表現。研究結果顯示：一、在本次所進行的客觀化結構式臨床測驗(Objective Structured Clinical Examination; OSCE)，將學生的臨床能力表現以具體量化之方式評估，可達到更為客觀之結果。二、經將OSCE測驗成績與學科成績及紙筆測驗卷成績做比較，結果顯示並無顯著相關。總之，本院在建立標準病人之評估方式後，將根據此一制度持續發展，以評估學生之臨床能力，期能培育優秀醫學人才，為國家社會貢獻最大心力。

Objective evaluation of clinical skills is an important approach to improve clinical ability. In the past, Taiwan has been relative lacking in effective evaluation methods. Traditional pen and paper testing only examines the students' level of knowledge and cannot evaluate actual clinical ability. In addition to regular clinical ability, a medical student should also have the training in how to handle emergency medical situations, so that they will be able to respond to such situations when they arise during their future medical practice. However, due to considerations of patient safety in true medical emergencies, interns have few opportunities to practice this type of clinical skill. In view of this problem, Tri-service General Hospital established a standardized patient training program for emergency medicine, together with relevant evaluation methods during 2004. The program's purpose was to provide intern students with opportunities to handle emergency situations and also to study the relationship between clinical evaluations obtained using standardized patients and compare this with traditional written examination results. For the evaluation described in this paper, eight cases were designed, which included such common medical emergencies as acute abdominal pain, high fever (including SARS), respiration difficulties, severe chest pain, acute renal colic, head trauma, abdominal trauma and lower back pain. Scripts were prepared, evaluation forms designed and training teams established; then professional actors were recruited and trained as the standardized patients. Students were then allowed to interact with the standardized patients in an actual clinic setting. They were evaluated in terms of their clinical performance and the results of the evaluation compared with their traditional examination results, including course grades and examination marks; the aim was an understanding of student achievement in this area. The results of the study indicated that firstly testing using standardized patients allows assessment of various types of clinical competence, which may then serve as a mean of improving student clinical performance. The study found that, using this method, which had a score range of 0-160, students scores ranged from a high of 138 to a low of 89 (average=110.9, standard deviation=11.5). This indicated that there was significant room for improvement in the students' clinical competence. Secondly, a comparison of scores using the standardized patients against the students' course grades and examination marks indicated that there was no significant correlation. This is consistent with a study performed in 2003 on evaluations using standardized patients at the Tri-Services General Hospital Neurology Department. It also corresponds with results from the literature in other countries, which have shown that academic scores and clinical skill evaluations do not show a good level of correlation. In conclusion, having established a standardized patient evaluation system, Tri-Service General Hospital will continue to develop this system in order to strengthen students' clinical abilities, with the aim of training outstanding medical personnel that contribute the maximum of their skills to society.

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