專業素養評估之高階OSCE工作坊專題報導

Special Report on a Faculty Development Workshop on Professionalism Evaluation of High-Stake OSCE

10.6145/jme.201106_15(2).0014

蔡詩力(Shih-Li Tsai)；黃琮芸(Chung-Yun Huang)；彭欣瑜(Hsin-Yu Peng)；何明蓉(Ming-Jung Ho)

客觀結構式臨床考試 ； 標準化病人 ； 醫學教育 ； 師資培育工作坊 ； objective structured clinical examination OSCE ； standardized patient ； medical education ； faculty development workshop

Journal of Medical Education

15卷2期（2011 / 06 / 01）

207 - 214

繁體中文

客觀結構式臨床考試(OSCE)改變以往醫學教育著重知識背誦的測驗方式，而更重視對醫學知識的體現。除了取得病史和理學評估，OSCE亦關注溝通態度與技巧，讓醫師具備同理心，並能有條理地組織病人所提供的資訊。Hodges教授說明標準化病人培訓應注意：謹慎篩選、提供良好的培訓、與醫療人員的互動與練習、品質控管以及職涯發展。此外，複合式模擬(hybrid simulation)提升了標準化病人的真實性，使OSCE更加貼近臨床情境。Hirsh教授認為OSCE是讓學生內化人文主義、同理心和道德最有效的途徑，藉由OSCE，學生不只學習如何當醫生，還可以追求成為一位「好」醫生。OSCE的評分亦是相當重要的環節，透過良好的評估設計與評估後即時的回饋，OSCE始能形塑社會所需要的醫生。從間接研究數據可得，OSCE有助增進醫病關係，更提供一個機制，降低不適當行為導致的醫療風險，以及提供課程方針修訂之參考依據。

The objective structured clinical examination (OSCE) has changed the method of assessing clinical competence in medical education, which in the past stressed memorization and the pedagogical knowledge students acquired in medical school. OSCE, on the other hand, emphasizes the realization of medical knowledge and the competence of clinical performance. In addition to tasks such as history taking and physical examination, OSCE also requires communication skills, and making physicians respond consistently in a perceptive and empathetic manner to the patient's needs and cues. Dr. Hodges demonstrates four steps in working with standardized patients: careful selection, good training, practice with health professionals, quality assurance, and continuing professional development. In addition, ”hybrid simulation” also enhances the authenticity of standardized patients, offering a context which is closer to the students' future working scenarios. Dr. Hirsh states that OSCE has become the most effective approach for medical students to internalize humanism, empathy and morality so that they not only learn how to be a doctor, but also seek to become a ”good” one. OSCE measures play an important role in the development of OSCE. By means of proper assessment design, and useful feedback to the adoption of OSCE, OSCE is able to create physicians that meet the needs of society. Indirect evidence from the previous studies shows that OSCE is able to help improve doctor-patient relationship at the clinical work. Moreover, OSCE also creates a mechanism which reduces the risks caused by inappropriate behaviors, and makes changes to the principles of courses in medical schools.

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