以迷你臨床演練評量評估牙醫系實習醫師之一般醫學臨床能力

Evaluation of the Clinical Competences of Dental Interns Using a Mini-CEX

10.6145/jme.201012_14(4).0004

楊盈盈(Ying-Ying Yang)；李發耀(Fa-Yauh Lee)；徐會祺(Hui-Chi Hsu)；高延壽(Yen-Shou Kao)；戴政宏(Cheng-Hung Tai)；鄭浩民(Hao-Min Cheng)；李文興(Wen-Shin Lee)；莊喬琳(Chiao-Lin Chuang)；張景智(Ching-Chi Chang)；陳震寰(Chen-Huang Chen)

牙醫實習醫師 ； 迷你臨床演練評量 ； dental intern ； mini clinical evaluation exercise mini-CEX

Journal of Medical Education

14卷4期（2010 / 12 / 01）

282 - 292

繁體中文

背景及目的：為能培養出利用全人醫療概念來提供全民口腔醫療照顧的牙醫師，牙醫學系實習醫師會固定至內、外科實習，此訓練應算是醫學院醫、牙整合課程之一大延伸。本研究目的為，評估牙醫學系實習醫師在內、外科訓練成果。方法：台北榮民總醫院一般醫學內科訓練示範中心自2008年起，固定為國立陽明大學牙醫實習醫師做迷你臨床演練(mini-clinical evaluation exercise, mini-CEX)評量。針對評量結果，分析台北榮總施行牙醫實習醫師的mini-CEX早期成效。結果：自2008年1月至2010年7月間，本中心共進行196名牙醫實習醫師之mini-CEX評量。本研究發現此mini-CEX之內部一致信度在0.79到0.86間，且三年來mini-CEX評量之信度有愈來愈來好的趨勢。另外，本研究也發現隨著在內、外科受訓時問之加長，牙醫實習醫師的mini-CEX之加總平均分數有越來越高之趨勢(p value for trend 0.04)，且mini-CEX表現進步之幅度以醫療面談及人道專業兩項目最顯著。另外本研究也發現，女性牙醫實習醫師在身體檢查及人道專業之表現，優於男性牙醫實習醫師。相反的，在組織效能方面，男性牙醫實習醫師之表現，優於女性牙醫實習醫師。最後，本研究也發現未到本中心受訓前就曾接受mini-CEX評量之學員，其在本中心之mini-CEX表現則優於其他從未接受過mini-CEX評量之牙醫實習醫師。結論：研究結果顯示，將來要積極規劃牙醫實習醫師，在每一內、外次專科實習期間皆安排mini-CEX的評量，累積多次觀察，可提供更可靠mini-CEX評量表現的結果。另外，評估mini-CEX應平均安排於各內、外次專科實習期間，以便能讓臨床教師及牙醫實習醫師有充裕的時問改進教與學的方法。

Objective: It is necessary to train dentists with the concepts of total patient care in order to produce best quality oral care for the Taiwanese. Dental interns need to take a 3 month internal (surgery) medicine training course as an extension of their medicine and dental-associated lectures. This study reports on the implementation of a dental mini-CEX within their internal medicine and surgery short-term training course at the General Internal Medicine Training Center of Taipei Veteran’s General Hospital. Methods: Since January 2008, a mini clinical evaluation exercise (mini-CEX) has been used to assess the clinical skills of dental interns from National Yang- Ming University as part of their medical training course. Results: From 2008 to 2010, the dental mini-CEX used 196 assessors and found that the internal consistency reliability of this assessment tool was good (Cronbach's α ranging from 0.79 to 0.86). Moreover, the reliability of the dental mini- CEX in our hospital increased progressively over the past three years. Additionally, we also found that the dental mini-CEX scores increased as the interns’ training courses were extended (p value for trend was 0.04). The most improvement was noted in the medicine interviewing skills and humanistic qualities/professionalism aspects of the dental mini- CEX. Interestingly, female dental interns showed the greatest improvement in both physical examination skills and humanistic qualities. Conversely, male dental interns showed the greatest improvement in organization/efficiency. Additionally, our study discovered that the dental mini-CEX scores were higher when the intern had undergone a prior exposure to a mini-CEX compared to those who had never been exposed to a mini-CEX. Conclusion: Our study found that assessment by regular mini-CEX of dental interns was a helpful way of evaluating these individuals and resulted in better clinical teachers who understood how to teach and assess the clinical competencies of internal medicine and surgery interns more fully. The mini-CEX also aided the self-improvement of dental interns.

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