臨床能力評(píng)估方法ppt課件

.,1,臨床能力的評(píng)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(píng)估工具分類(lèi),筆試paper-basedtestMCQ,shortessay.口試oralexaminationStandardizedoralexam,CbD/CSR.情境模擬simulationOSCE,simulator,screen-basedsimulation,virtualreality.實(shí)地評(píng)核workplace-basedevaluationDOPS,Mini-CEX,PAT,patientsurvey,MSF(360。).,.,5,OSCE,Objective客觀(guān)的AllthecandidatesarepresentedwiththesametestStructuredClinicalexaminationStructured有結(jié)構(gòu)的ThemarkingschemeforeachstationisstructuredSpecificskillmodalitiesaretestedateachstation,eg.Historytaking,Clinicalexamination,Explanation,ProceduresClinicalExamination臨床測(cè)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(cè)驗(yàn)”1975年由英國(guó)Dundee大學(xué)Dr.R.M.Harden提出它是一種在模擬臨床場(chǎng)景下，使用模型、標(biāo)準(zhǔn)化病人甚至病人來(lái)測(cè)試醫(yī)學(xué)生臨床能力的考核方法同時(shí)它也是一種知識(shí)、技能和態(tài)度并重的綜合能力評(píng)估的方法。,.,7,OSCE考試內(nèi)容,病史詢(xún)問(wèn)(Historytaking)身體檢查(Physicalexamination)溝通技巧(Communicationskill)咨商衛(wèi)教(Counseling回饋與評(píng)(5-10分鐘)由學(xué)員找?guī)煈?yīng)試,.,23,MiniCEX執(zhí)行方式,時(shí)間,人員,事情,地點(diǎn),物件,隨時(shí)、每次約1520分鐘,一位臨床老師一位學(xué)員一位病患,觀(guān)察學(xué)員臨床技能,病房、門(mén)診、急診、ICU,評(píng)量紀(jì)錄單,.,24,DOPS,DirectObservationofproceduralSkills操作型技術(shù)評(píng)量表由評(píng)分者直接觀(guān)察受訓(xùn)者實(shí)務(wù)性技術(shù)的技巧并給予評(píng)量,.,25,以DOPS之Procedures,VenipunctureIVCannulationArterialpunctureBloodcultureSubcutaneousinjectionIntradermalinjectionIntramuscularinjectionIVinjection,PerformandinterpretspirometryUrethralcatheterizationNasogastrictubeinsertionIntubationUseoflocalanestheticsAirwaycare,.,26,DOPS的評(píng)分項(xiàng)目,對(duì)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(wú)菌技術(shù)必要時(shí)尋求協(xié)助程序后序管理溝通技巧考慮病人感受與專(zhuān)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(guò)訓(xùn)練及有經(jīng)驗(yàn)的教師12位負(fù)責(zé)考問(wèn)考問(wèn)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(jì)劃等考試時(shí)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(píng)量者的人評(píng)分評(píng)分者可包括:上-主治醫(yī)師、護(hù)理長(zhǎng)、總住院醫(yī)師下-實(shí)習(xí)醫(yī)師、見(jiàn)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(píng)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(duì)醫(yī)院、門(mén)診、住院回診的滿(mǎn)意度針對(duì)醫(yī)師/護(hù)理人員的不同面向做評(píng)估病人照護(hù)能力回診時(shí)間治療計(jì)劃服務(wù)態(tài)度,.,30,Peerassessmenttool-PAT評(píng)量項(xiàng)目范例,能辯識(shí)問(wèn)題能訂妥當(dāng)處置計(jì)劃了解自己之權(quán)限能對(duì)疾病之社會(huì)心理層面作反應(yīng)能妥善使用資源時(shí)間及優(yōu)先級(jí)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(yǔ)言溝通與同事之文字溝通能他人之貢獻(xiàn)與價(jià)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(gè)真實(shí)病例做表現(xiàn)評(píng)估考問(wèn)老師必須先接受過(guò)口試訓(xùn)練考問(wèn)老師先陳述一個(gè)病例再提出臨床考題每一病例的考問(wèn)時(shí)間為3-5分鐘,.,33,Paper-basedtest,WrittenexaminationMultiplechoicequestions(MCQs)ShortessayPsychometricqualities/ConstructvalidityFormative/summativeQuiz/nationallicensingexamination,.,34,臨床能力評(píng)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(zhuān)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(jiàn),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(guò)開(kāi)放式的問(wèn)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