临床能力评估方法PPT课件

.,1,临床能力的评量,.,2,Modelofcompetence,Cognitionknowledge,BehaviourSkills/attitudes,Professionalauthenticity,MillerGE.Theassessmentofclinicalskills/competence/performance.AcademicMedicine(Supplement)1990;65:S63-S67.,.,3,Measurementofeachlevelofthemodel,Action,Performance,Competence,Knowledge,360-Degree,.,4,临床能力评估工具分类,笔试paper-basedtestMCQ,shortessay.口试oralexaminationStandardizedoralexam,CbD/CSR.情境模拟simulationOSCE,simulator,screen-basedsimulation,virtualreality.实地评核workplace-basedevaluationDOPS,Mini-CEX,PAT,patientsurvey,MSF(360。).,.,5,OSCE,Objective客观的AllthecandidatesarepresentedwiththesametestStructuredClinicalexaminationStructured有结构的ThemarkingschemeforeachstationisstructuredSpecificskillmodalitiesaretestedateachstation,eg.Historytaking,Clinicalexamination,Explanation,ProceduresClinicalExamination临床测验Testofperformanceofclinicalskills:notatestofknowledgeThecompetenceof“ShowHow”,.,6,OSCE定义及发展,OSCE（ObjectiveStructuredClinicalExamination）是以操作为基础的测验”1975年由英国Dundee大学Dr.R.M.Harden提出它是一种在模拟临床场景下，使用模型、标准化病人甚至病人来测试医学生临床能力的考核方法同时它也是一种知识、技能和态度并重的综合能力评估的方法。,.,7,OSCE考试内容,病史询问(Historytaking)身体检查(Physicalexamination)沟通技巧(Communicationskill)咨商卫教(Counseling回馈与评(5-10分钟)由学员找师应试,.,23,MiniCEX执行方式,时间,人员,事情,地点,物件,随时、每次约1520分钟,一位临床老师一位学员一位病患,观察学员临床技能,病房、门诊、急诊、ICU,评量纪录单,.,24,DOPS,DirectObservationofproceduralSkills操作型技术评量表由评分者直接观察受训者实务性技术的技巧并给予评量,.,25,以DOPS之Procedures,VenipunctureIVCannulationArterialpunctureBloodcultureSubcutaneousinjectionIntradermalinjectionIntramuscularinjectionIVinjection,PerformandinterpretspirometryUrethralcatheterizationNasogastrictubeinsertionIntubationUseoflocalanestheticsAirwaycare,.,26,DOPS的评分项目,对适用状况相关解剖与技术程序展现了解取得informedconsent展现妥善准备程序妥善止痛或安全镇静具程序所需之技能无菌技术必要时寻求协助程序后序管理沟通技巧考虑病人感受与专业性执行程序的整体能力,.,27,CbD/CSR,Case-basedDiscussion(CbD)inEnglandChartstimulatedRecallOralExamination(CSR)inUSAandCanadaAkindofstandardizedoralexamination由考生准备自己记录的病历或病历摘要由接受过训练及有经验的教师12位负责考问考问内容:安排各种检查的理由检查的判读临床发现的代表意义诊断治疗计划等考试时间:为5-10分钟考试病历:共考3-6本病历或症摘,.,28,360oevaluation/MSF,360-DegreeEvaluationinUSAandCanada由最近经常接触被评量者的人评分评分者可包括:上-主治医师、护理长、总住院医师下-实习医师、见习医师左-其他住院医师、护理人员右-病人、家属Multi-sourcefeedbackinEnglandPatientsurvey(orpatientsatisfactionquestionnaireinUSA)Peerassessmenttool(PAT)Teamassessmentofbehavior(TAB)由学员提名评分者包括:导师、教师、护理、同侪及其他医疗人员,.,29,Patientsurvey,调查病人对医院、门诊、住院回诊的满意度针对医师/护理人员的不同面向做评估病人照护能力回诊时间治疗计划服务态度,.,30,Peerassessmenttool-PAT评量项目范例,能辩识问题能订妥当处置计划了解自己之权限能对疾病之社会心理层面作反应能妥善使用资源时间及优先级安排妥当压力处理能力,执行技术正确愿意且有效指导同事与病人之沟通与照顾者家属沟通尊重病人的隐私与同事之语言沟通与同事之文字沟通能他人之贡献与价值可得性及可信性,.,31,Portfolio/passport,Portfolio学习历程Passport学习护照Procedure,OperativeorCaseLogs由学员汇集各项学习的证明及成果,.,32,StandardizedoralExamination,使用18-60个真实病例做表现评估考问老师必须先接受过口试训练考问老师先陈述一个病例再提出临床考题每一病例的考问时间为3-5分钟,.,33,Paper-basedtest,WrittenexaminationMultiplechoicequestions(MCQs)ShortessayPsychometricqualities/ConstructvalidityFormative/summativeQuiz/nationallicensingexamination,.,34,临床能力评量的回馈,澄清、提示重點、促進改善,.,35,临床教师须予适当回馈之处,面谈技巧MedicalInterviewingSkills身体检查Physicalexaminationskills咨商技巧CounselingSkills临床判断ClinicalJudgment专业素养HumanisticQualities/Professionalism组织能力及效率Organization/Efficiency整体表现OverallClinicalCompetence,.,36,临床教育进行回馈的五大步骤,Getacommitment(aplan):设定教学目标让学员先抒发己见,了解学习需求,设定教学目标Probeforsupportingevidence:探索证据支持透过开放式的问题,了解学员的思路Teachgeneralrules:教导一般性原则原则性教学,训练分析思考