DxR Clinician虛擬病例在臨床能力考試上的應用

Application of DxR Clinician Virtual Patients in Clinical Competency Examinations

10.6145/jme.200906_13(2).0002

葉建宏(Jiann-Horng Yeh)；劉樹泉(Shu-Chuen Lau)；劉榮森(Jung-Sen Liu)；周定遠(Ting-Ywan Chou)；邱浩彰(Hou-Chang Chiu)；鄒國英(Kuo-Inn Tsou)；楊巧如(Chiau-Ru Yang)

客觀結構式臨床考試 ； 虛擬病例 ； DxR Clinician ； 臨床能力 ； objective structured clinical examination ； virtual patient ； DxR Clinician ； clinical competency

Journal of Medical Education

13卷2期（2009 / 06 / 01）

84 - 91

繁體中文

The DxR Clinician (DxR) virtual patient is mainly utilized by medical students in Taiwan to improve their clinical reasoning ability through a self-learning process. In this context, Fu-Jen University College of Medicine was the first medical school in Taiwan to implement a DxR case test as part of an objective structured clinical examination (OSCE) for clerkship, which was named the Clinical Competence Examination (CCX). This study collected 378 CCX records from the school years 94 to 95 and analyzed the variations between and correlation among the DxR scores, the standardized patient (SP) scores, and the teacher scores for the OSCE. The mean DxR score was 74.7 points, the mean SP score was 73.1 and the mean teacher score was 62.2, based on all of the 378 records. The teacher scores were signifi cantly lower than either the DxR scores or SP scores (p＜0.0001). Interestingly, the mean DxR scores varied widely across the six medical specialties, ranging from a highest of 91.8 points in gynecology to a lowest of 68 points in family medicine (p＜0.0001). In contrast, the mean teacher scores across the specialties were relatively homogenous except for a significantly lower score for surgery (p=0.0020). However, in terms of SP scores across the specialties, there were no significant differences. Analyzing the correlations across all three sets of scores, we found the DxR scores had no correlation with the SP scores. In contrast, the DxR scores were negatively correlated with the teacher scores in general (p=0.0031) and the junior clerk scores (p=0.0004). In summary, the application of the DxR case test, as part of the OSCE for clerkship, was feasible and practical based on this first study after analyzing the initial two years of CCX experience in Taiwan. This CCX system provides a more comprehensive evaluation of the student's overall learning because it is based on two distinct aspects, namely clinical skill assessment using the OSCE and clinical reasoning assessment using the DxR.

The DxR Clinician (DxR) virtual patient is mainly utilized by medical students in Taiwan to improve their clinical reasoning ability through a self-learning process. In this context, Fu-Jen University College of Medicine was the first medical school in Taiwan to implement a DxR case test as part of an objective structured clinical examination (OSCE) for clerkship, which was named the Clinical Competence Examination (CCX). This study collected 378 CCX records from the school years 94 to 95 and analyzed the variations between and correlation among the DxR scores, the standardized patient (SP) scores, and the teacher scores for the OSCE. The mean DxR score was 74.7 points, the mean SP score was 73.1 and the mean teacher score was 62.2, based on all of the 378 records. The teacher scores were signifi cantly lower than either the DxR scores or SP scores (p＜0.0001). Interestingly, the mean DxR scores varied widely across the six medical specialties, ranging from a highest of 91.8 points in gynecology to a lowest of 68 points in family medicine (p＜0.0001). In contrast, the mean teacher scores across the specialties were relatively homogenous except for a significantly lower score for surgery (p=0.0020). However, in terms of SP scores across the specialties, there were no significant differences. Analyzing the correlations across all three sets of scores, we found the DxR scores had no correlation with the SP scores. In contrast, the DxR scores were negatively correlated with the teacher scores in general (p=0.0031) and the junior clerk scores (p=0.0004). In summary, the application of the DxR case test, as part of the OSCE for clerkship, was feasible and practical based on this first study after analyzing the initial two years of CCX experience in Taiwan. This CCX system provides a more comprehensive evaluation of the student's overall learning because it is based on two distinct aspects, namely clinical skill assessment using the OSCE and clinical reasoning assessment using the DxR.

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