臨床能力評估 - sltung.com.t · (acgme)1999年六項稱職能力 1. ......
Transcript of 臨床能力評估 - sltung.com.t · (acgme)1999年六項稱職能力 1. ......
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Mini-CEX, CbD, DOPS
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2003:()
2006:()
2007:
2009:
PGY()
2011:PGY
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Paradigm of Education
MSF
OSCE
Mini-CEX
CbD
DOPS
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Lecture
PBL
Bed side
OPD
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3.
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ACGME1999
1. ( patient care)
2. (medical knowledge)
3. (professionalism)
4. (communication and
interpersonal skills)
5. ( systems-based practice)
6. (practice-based learning and
improvement)
1. What you do
2. What you know
3. How You Interact
with Others
4. How You Act
5. How You Work
Within the System
6. How You Get Better
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Competence Based Learning
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: Mini-CEX CbD DOPS
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(evaluation)
: (evaluation as measurement)
: (evaluation as determining congruence)
: (evaluation as professional judgement)
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44786
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Scriven
The goal of evaluation is not to prove but to
improve.
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Mini-CEX, DOPS
OSCE
Case Based Discussion
Miller GE, Acad Med 1990
Dose
Shows how
Knows how
Knows
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(MCQ)
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(Leniency error)
(Severity error)
(Halo effect)
(First impression error)
(Friendship bias)
Substantial variations in ratings between faculty
members
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Implications For Assessment Today
Do not rely on short tests
In order to make tests sufficiently reiable, a broad
sample must be used
Questions that take longer to answer produce in
general less reliable tests than questions that
allow for a quick answer
Do not rely on one method
No one single tool in panacea
Examination programme that consist of a variety
of carefully selected and combined methods
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Workplace-based Assessment
Outcomes-based Assessment
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Mini-CEX=; mini-PAT=;TAP=(); DOPS=: CBD=: SLI=()
:,mini-CEX.
2005 F2
Mini-
CEX
Mini-Pat,
TAB
DOPS CBD
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For more knowledge-based aspects: MCQs
For problem-solving: many short cases-
based questions asking for essential decision
making
Observations in practice: kept short and
mildly structured & by different examiners
Mini-CEX
Assessment of attitude: frequent observation
of professional behavior in various settings
Discussion and feedback
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( Multi-source fedback, MSF)
Mini clinic evaluation exercise (min-CEX)
Direct observation of procedure skills (DOPS)
Case based discission (CbD)
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(https://pec.doh.gov.tw/Security/Login_pgy.aspx
99 4 12 0990066542 100 5 16 1000261810 100 10 4 1000264886 101 6 6 1010264674 102 2 5 1020268877
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1360 2360 / 3 4 51 Mini-CEX CbD DOPS
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/ PA (UGY) PGY
(Learning Passport) V V V
(MSF) V V V
V
(EBM) PICO/CAT V V V
(Mini-CEX) V V V
(OSCE) V V
(DOPS) V V V
(CbD) V V V
(Chart Round) V V
(MCQ) V V
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: (Mini-CEX )
(CbD)
(DOPS)
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Mini-CEX?
(ABMS)ACGME
mini-CEX
. (medical interviewing skills)
. (physical examination skills)
. (professionalism)
. (clinical judgment)
. (counseling skills)
. (organization/efficiency)
. (overall competence)
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Mini-CEX
(15-20)
(5-10)
Chen W, et al. J Med Education
2005.
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Mini-CEX
Mini-CEX
1-3 4-6 7-9
4 5 6 7 8
M5 M6 M7 R1 R2 R3 _____
__________
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____________________________________________
1.
1 2 3 4 5 6 7 8 9
2.
1 2 3 4 5 6 7 8 9
3.
1 2 3 4 5 6 7 8 9
4.
1 2 3 4 5 6 7 8 9
5.
1 2 3 4 5 6 7 8 9
6.
1 2 3 4 5 6 7 8 9
7.
1 2 3 4 5 6 7 8 9
____________
1 2 3 4 5 6 7 8 9
1 2 3 4 5 6 7 8 9
______________________________________________________________________
______________________________________________________________________
_____________________________________
_________________________
________________________
Mini-CEX
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Mini-CEX
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,
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mini-CEX
mini-CEX
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Immediate
5-10 minutes
Self-assessment
Recommendations
21%
10%
1%68%
Less specific
Only positive
No written
Specific Postiveand negative
Yeh JH,etal; J Med Education
2008;12:77-83
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(CbD) Case-based Discussion
National Healthcare System (NHS)Healthcare Assessment and Training (HCAT)
Foundation Program (PGY Program)
clinical reasoning
decision-making
reasoning
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Foundation Program
CbD
(assessor)
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CbD
155
CbDHCAT
HCATmailFoundation Program
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CbD:
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CbD
16 12
34
56
U/C (unable to comment)
HCAT
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(video)
(video)
(calibration)
(instant & bidirectional feedback)
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(DOPS) Direct Observation of Procedural Skill
Check List Mini-CEX procedures
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DOPS
15-20
5
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1. D011
2.() D021
3. D031
4. D041
5. D051
6. D061
7. D071
9. D091
10. D101
11. D111
12. D121
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()( )
1 Venepuncture 9 ID Injection
2 Cannulation 10 IM Injection
3 () Blood Culture (Peripheral) 11 I V Injection
4 () Blood Culture (Central) 12 Urethral Catheterization
5 IV Infusions 13 Airway Care
6 ECG 14 NG Tube Insertion
7 Arterial Blood Sampling (Radial/Femoral stab)
15 Central vein Catheterization i.e. DLC, CVP
8 SC Injection 16 Organ puncture Liver, Kidney biopsy
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DOPS
6 DOPS
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Mini-CEX, CbD, DOPS, OSCE
Mini-CEX 96 -11 96-11
98-6-26
99-7-2
99-12-17
99-12-17
100-2-21,6-23
101-4-25*
CbD 100-2 98-6-26
99/7-2
99-12-17
101-2-22
101-8-25*
DOPS 100-8 98-6/26
99-7-2
99-12-17
100-8-21,
100-11-2
101-6-28*
OSCE PGY1
101-6
102-6
98-6-26,12-26
99-7-2
101-12
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102 1CbD 1020206()16:00
17:00 -16
3118 04-2463200053675
1
15:50-16:00
16:00-16:20
CbD
16:20-16:40
()
16:40-17:00
(
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17:10
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, 6, Min-CEX, CbD, DOPS2.
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, 1/20.
!, . (TEL: 53674)
2012
1 222 CbD
2 411 Mini-CEX
3 627 DOPS
4 822 CbD
5 1026 Mini-CEX
1026 X DOPS
6 1212 DOPS
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, 6, Min-CEX, CbD, DOPS2.
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!, . (TEL: 53674)
2013
1 26 CbD
2 43 DM Mini-CEX
3 65 DOPS
4 821 CbD
5 1030 Ankle sprain Mini-CEX
6 1218 DOPS
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1007
CbD, Mini-CEX, DOPS
CbD, DOPS6
Mini-CEX 9
1-23-45-6
1-34-67-9
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Mini-CEX
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Case based Discussion
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cc
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teacher
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CbD 10071026
184
173
2CbD
CbD
100 07-12
101 01-06
101 07-12
102 01-06
12 16 16 16
11 12 9 8
33 62 26 29
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CbD 7:
7 :
1007-12 10101-6 1017-12 10201-6
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1. 3.7420.682 3.7190.491 3.840.554 4.3850.697 0.6427 17.2% 0.001**
2. 3.7670.568 3.770.589 3.8850.766 4.2410.739 0.4747 12.6% 0.008*
3. 3.8930.497 3.8270.513 3.920.572 4.3570.678 0.4643 11.9% 0.005*
4. 3.8710.562 3.8770.381 3.840.473 4.1850.681 0.3142 8.1% 0.059
5. 3.8620.693 3.7640.508 3.9090.812 4.250.737 0.3879 10.0% 0.054
6. 3.8210.548 3.9430.497 3.8180.588 4.4170.776 0.5952 15.6% 0.002**
7. 3.9310.53 4.0190.416 4.1430.573 4.3460.745 0.4151 10.6% 0.020*
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CbD
1007-12CbD 33
(n33)
1 C01-06 10 30%
2 C01-02 8 24%
3 C02-01 7 21%
(n 33)
1 C02-02 8 24%
2 C06-02 8 24%
3 C06-04 7 21%
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CbD
10201-6CbD 29
(n 29)
1 C02-01
11 38%
2 C03-01 9 31%
3 C01-01 7 24%
(n 29)
1 C01-10 6 21%
2 C03-03 6 21%
3 C06-05 5 17%
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Take Home Message
Mini-CEX, CbD,
DOPS
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