Implementation of the Mini-CEX (Clinical Evaluation Exercise): Experiences and Preliminary Results
Keywords教學評量,回饋,直接觀察,迷你臨床演練評量;teaching assessment,feedback,direct observation,mini-CEX Clinical Evaluation Exercise
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Abstract[[abstract]]迷你臨床演練評量(mini-CEX)藉著臨床教師直接觀察醫學生或住院醫師與病人之互動，依醫療面談、身體檢查、人道專業、臨床判斷、諮詢建議、組織效能及整體評量七項指標給予評量及回饋，已在多國實施，本文介紹在台灣建置mini- CEX之經驗，並報告工作坊及試辦之結果。經由印製中文版評量手冊，訓練種子教師，以及舉辦三場工作坊：包括簡報講解、分組錄影帶研習、小組報告及綜合討論、錄影帶模擬評量及回饋等方式，訓練臨床教師及醫學生後，開始進行試辦。工作坊共訓練389名師生，參與者大多能理解實施方式及評量項目，錄影帶模擬評量亦顯示參與者能分辨診療行為之優劣。試辦期共執行了115次mini-CEX，分別由主治醫師或住院醫師擔任教師，平均執行時間不到30分鐘。 mini-CEX的評量項目與學習目標相符，信效度已被國外證實，能同時有量化及敘述性的資料，可行性極高，僅需加強評量項目與評分等級的訓練，應該可以彌補目前臨床教學缺少直接觀察的缺陷，達成多元評量的目的。 Mini-CEX (Clinical Evaluation Exercise) is being implemented in many countries and involves the direct observation of encounters between medical students or residents and the patient. The evaluator rates the student's performance based on seven items: medical interviewing skills, physical examination skills, humanistic qualities/professionalism, clinical judgment, counseling skills, organization/efficiency, and overall clinical competence; then feedback to the student/resident is given by the evaluator. This paper aim to describe experiences during the implemention of mini-CEX in Taiwan and to present the results from a training workshop and pilot study. The process involved the printing of a Chinese edition mini-CEX booklet, the training of core teachers and the holding of three workshops. The workshops included an introductional presentation, a video-tape exercise, small group discussions and a mock test using a separate different videotape. Furthermore, a pilot study was started after the clinical teachers and intern students had become familiar with how mini-CEX works. A total of 389 participants were trained during the workshops. After the workshops, it was found that most participants were able to understand the mini-CEX approach and the system's evaluation items. The results of mock test also showed that participants were able to distinguish the various performance quality levels during the patient/doctor encounter. During the pilot study, 115 mini-CEXs were carried out. An attending doctor or the resident served as rater for an intern student and the average execution time was less than 30 minutes. The popularization of the mini-CEX is recommended because it fulfills the following specific criteria needed for clinical assessment. Firstly, there should be multiple assessments by multiple observers using multiple tools at multiple time points. Secondly, the tools should be reliable, reproducible and valid. Thirdly, the tools must be practical, that is feasible, convenient, low time commitment, easy to use, inexpensive to implement and inexpensive to maintain. Fourthly, the tools must produce both qualitative and quantitative data. Fifthly, the assessment process must be linked to the learning objectives. Finally, the grading scale should be open and clearly defined. By strengthening the training of raters so that they execute their assessment in an unbiased manner, mini-CEX is able to help make up for any deficiencies in the limited number of other direct obervation assessments made during current clinical teaching.