標準化病人及標準化病人訓練師演出評量工具之開發

Abstract

背景：客觀結構式臨床測驗（Objective Structured Clinical Examination, OSCE）之目的在於評量有別於傳統筆試所無法測驗之面向。Mini-Clinical Examination（Mini-CEX）則是一種廣為世界採用之醫學教育迷你臨床測驗評估量表。標準化病人是OSCE的一大特色，然而目前評估的量表稍嫌複雜。 目的：我們想要探討及發展具有迷你臨床測驗概念又適合國內民情及醫學教育需求的量表，可以針對標準化病人及標準化病人訓練師的訓練、評估及考核都能適用的迷你評估表。 方法：我們主要使用焦點團體法提名因素項目，進一步討論命名、歸納或刪除項目因子；預評之後會再進行項目分析，並以因素分析（Factor analysis）的主成分分析法（Principal Component Analysis）釐清重要性，經過信度與效度的分析與探討建立正式量表。正式量表再經過多次的施測，評定驗證量表的信度與效度。 結果：實際運用標準化病人評分量表來評估所有標準化病人的表現， Cronbach α 值為 0.982。標準化病人訓練師評分量表Cronbach α 值則為 0.919。用Pearson correlation 的方法檢定兩個量表所有評核項目兩兩之間彼此的相關性，都可以達到統計學上P<0.01非常顯著的意義。用主成份法的方法來進行標準化病人迷你評分量表各因素的因子分析所得到的各項因素重要性分析平均都在0.9以上。 結論：本研究發展一個以新思維創新卻簡易方便的評估量表來評核標準化病人之訓練與演出，讓從事訓練標準化病人之標準化病人訓練師，無論是否有醫療背景，均能輕易上手，方便標準化病人的訓練與評估。

Background: Objective Structured Clinical Examination (OSCE) aims to test the medical students in the domains different from the traditional exams. Mini-Clinical Examination (Mini-CEX) is one popular and convenient tool to assess the medical clinical skills. Standardized patients (SPs) are one characteristic of the OSCE but the current format is complicated to evaluate their performance. Objective: We wanted to develop simple and feasible tools to evaluate the performance of SPs and standardized patient trainer (SPT) for the purposes of training and assessment inspired by the convenience of mini-CEX. Methods: We developed and nominated the items of the scales by the focus group method and tested the reliability by Cronbach α and the validation by the factor analysis. All statistics were analyzed by SPSS 12.0 and defined the significance by P<0.05. Result: The Cronbach α of the scales to assess SPs and SPTs were 0.982 and 0.919. Both scales showed significant by Pearson correlation (P<0.01). The factor analysis showed good validity of the scale to check SPs by principle component method. Conclusion: We developed and demonstrated convenient and feasible tools to assess the SPs and SPTs with good reliability and validity to improve the training and education.