臨床能力評估方法ppt課件

.,1,臨床能力的評量,.,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,臨床能力評估工具分類,筆試paper-basedtestMCQ,shortessay.口試oralexaminationStandardizedoralexam,CbD/CSR.情境模擬simulationOSCE,simulator,screen-basedsimulation,virtualreality.實(shí)地評核workplace-basedevaluationDOPS,Mini-CEX,PAT,patientsurvey,MSF(360。).,.,5,OSCE,Objective客觀的AllthecandidatesarepresentedwiththesametestStructuredClinicalexaminationStructured有結(jié)構(gòu)的ThemarkingschemeforeachstationisstructuredSpecificskillmodalitiesaretestedateachstation,eg.Historytaking,Clinicalexamination,Explanation,ProceduresClinicalExamination臨床測驗(yàn)Testofperformanceofclinicalskills:notatestofknowledgeThecompetenceof“ShowHow”,.,6,OSCE定義及發(fā)展,OSCE（ObjectiveStructuredClinicalExamination）是以操作為基礎(chǔ)的測驗(yàn)”1975年由英國Dundee大學(xué)Dr.R.M.Harden提出它是一種在模擬臨床場景下，使用模型、標(biāo)準(zhǔn)化病人甚至病人來測試醫(yī)學(xué)生臨床能力的考核方法同時它也是一種知識、技能和態(tài)度并重的綜合能力評估的方法。,.,7,OSCE考試內(nèi)容,病史詢問(Historytaking)身體檢查(Physicalexamination)溝通技巧(Communicationskill)咨商衛(wèi)教(Counseling回饋與評(5-10分鐘)由學(xué)員找?guī)煈?yīng)試,.,23,MiniCEX執(zhí)行方式,時間,人員,事情,地點(diǎn),物件,隨時、每次約1520分鐘,一位臨床老師一位學(xué)員一位病患,觀察學(xué)員臨床技能,病房、門診、急診、ICU,評量紀(jì)錄單,.,24,DOPS,DirectObservationofproceduralSkills操作型技術(shù)評量表由評分者直接觀察受訓(xùn)者實(shí)務(wù)性技術(shù)的技巧并給予評量,.,25,以DOPS之Procedures,VenipunctureIVCannulationArterialpunctureBloodcultureSubcutaneousinjectionIntradermalinjectionIntramuscularinjectionIVinjection,PerformandinterpretspirometryUrethralcatheterizationNasogastrictubeinsertionIntubationUseoflocalanestheticsAirwaycare,.,26,DOPS的評分項(xiàng)目,對適用狀況相關(guān)解剖與技術(shù)程序展現(xiàn)了解取得informedconsent展現(xiàn)妥善準(zhǔn)備程序妥善止痛或安全鎮(zhèn)靜具程序所需之技能無菌技術(shù)必要時尋求協(xié)助程序后序管理溝通技巧考慮病人感受與專業(yè)性執(zhí)行程序的整體能力,.,27,CbD/CSR,Case-basedDiscussion(CbD)inEnglandChartstimulatedRecallOralExamination(CSR)inUSAandCanadaAkindofstandardizedoralexamination由考生準(zhǔn)備自己記錄的病歷或病歷摘要由接受過訓(xùn)練及有經(jīng)驗(yàn)的教師12位負(fù)責(zé)考問考問內(nèi)容:安排各種檢查的理由檢查的判讀臨床發(fā)現(xiàn)的代表意義診斷治療計劃等考試時間:為5-10分鐘考試病歷:共考3-6本病歷或癥摘,.,28,360oevaluation/MSF,360-DegreeEvaluationinUSAandCanada由最近經(jīng)常接觸被評量者的人評分評分者可包括:上-主治醫(yī)師、護(hù)理長、總住院醫(yī)師下-實(shí)習(xí)醫(yī)師、見習(xí)醫(yī)師左-其他住院醫(yī)師、護(hù)理人員右-病人、家屬M(fèi)ulti-sourcefeedbackinEnglandPatientsurvey(orpatientsatisfactionquestionnaireinUSA)Peerassessmenttool(PAT)Teamassessmentofbehavior(TAB)由學(xué)員提名評分者包括:導(dǎo)師、教師、護(hù)理、同儕及其他醫(yī)療人員,.,29,Patientsurvey,調(diào)查病人對醫(yī)院、門診、住院回診的滿意度針對醫(yī)師/護(hù)理人員的不同面向做評估病人照護(hù)能力回診時間治療計劃服務(wù)態(tài)度,.,30,Peerassessmenttool-PAT評量項(xiàng)目范例,能辯識問題能訂妥當(dāng)處置計劃了解自己之權(quán)限能對疾病之社會心理層面作反應(yīng)能妥善使用資源時間及優(yōu)先級安排妥當(dāng)壓力處理能力,執(zhí)行技術(shù)正確愿意且有效指導(dǎo)同事與病人之溝通與照顧者家屬溝通尊重病人的隱私與同事之語言溝通與同事之文字溝通能他人之貢獻(xiàn)與價值可得性及可信性,.,31,Portfolio/passport,Portfolio學(xué)習(xí)歷程Passport學(xué)習(xí)護(hù)照Procedure,OperativeorCaseLogs由學(xué)員匯集各項(xiàng)學(xué)習(xí)的證明及成果,.,32,StandardizedoralExamination,使用18-60個真實(shí)病例做表現(xiàn)評估考問老師必須先接受過口試訓(xùn)練考問老師先陳述一個病例再提出臨床考題每一病例的考問時間為3-5分鐘,.,33,Paper-basedtest,WrittenexaminationMultiplechoicequestions(MCQs)ShortessayPsychometricqualities/ConstructvalidityFormative/summativeQuiz/nationallicensingexamination,.,34,臨床能力評量的回饋,澄清、提示重點(diǎn)、促進(jìn)改善,.,35,臨床教師須予適當(dāng)回饋之處,面談技巧MedicalInterviewingSkills身體檢查Physicalexaminationskills咨商技巧CounselingSkills臨床判斷ClinicalJudgment專業(yè)素養(yǎng)HumanisticQualities/Professionalism組織能力及效率Organization/Efficiency整體表現(xiàn)OverallClinicalCompetence,.,36,臨床教育進(jìn)行回饋的五大步驟,Getacommitment(aplan):設(shè)定教學(xué)目標(biāo)讓學(xué)員先抒發(fā)己見,了解學(xué)習(xí)需求,設(shè)定教學(xué)目標(biāo)Probeforsupportingevidence:探索證據(jù)支持透過開放式的問題,了解學(xué)員的思路Teachgeneralrules:教導(dǎo)一般性原則原則性教學(xué),訓(xùn)練分析思考