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研究生:賴向華
研究生(外文):Eddie Hsiang-Hua Lai
論文名稱:牙醫臨床技能評估測驗之建構
論文名稱(外文):Construction of dental clinical skill examination
指導教授:林俊彬林俊彬引用關係
指導教授(外文):Chun-Pin Lin
口試委員:林立德高嘉澤謝義興涂明君鄭景暉
口試日期:2014-05-31
學位類別:博士
校院名稱:國立臺灣大學
系所名稱:臨床牙醫學研究所
學門:醫藥衛生學門
學類:牙醫學類
論文種類:學術論文
論文出版年:2014
畢業學年度:102
語文別:中文
論文頁數:107
中文關鍵詞:臨床實作評量客觀結構式臨床測驗名義團體技巧
外文關鍵詞:Performance assessmentObjective Structured Clinical ExaminationNominal Group Technique
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近年來醫療服務的觀念皆強調以病人為中心,醫學教育的方向也除了傳統醫療知識傳授,更著重技能的訓練與態度的培養。牙醫師的臨床技能需要被確實教導與評量是無庸置疑的,臨床實作評量 (Performance Assessment),而其中又包含了客觀結構式臨床測驗 (Objective Structured Clinical Examination, OSCE),應用於牙科的訓練成效評估,已在各國實施多年,目的是利用實際操作來檢視牙醫學生面對醫療工作是否已經具備足夠的臨床能力。許多研究顯示藉由OSCE 比紙本筆試更能評量學生真正之臨床能力。因此OSCE便成為評量臨床技能的重要工具之ㄧ,近年來更成為美加與日本醫師執照考試的一部份,如:醫病溝通、病歷詢問及臨床診察技巧等測驗。
臺灣大學牙醫專業學院為提昇牙醫學教育品質,成立OSCE 小組,進行包括試務指引開發及教師訓練。小組進行資料收集與文獻回顧,藉由探討各國核心能力訂定之異同及運用名義團體技巧 (Nominal Group Technique) 訂定本院牙醫學系學生畢業時需具備之臨床核心能力,並據此確定本院OSCE之配題藍圖 (blueprint)。在一系列之教師訓練課程後,接著進行考題開發,並利用迷你-客觀結構式臨床測驗 (mini-OSCE) 進行考官信效度測試,最後進行院內三個不同階層共三十六位學生進行六站之OSCE,測驗結果除可提供臨床教師擬定教學內容和未來修正課程規劃的方向外,亦希望本考試之建構過程亦可提供各牙醫學院後,於在未來推行OSCE 時做為參考。

關鍵詞:臨床實作評量、客觀結構式臨床測驗、名義團體技巧


The concept of “Patient Center” is emphasized in the medical care recently. Dental education in addition to the traditional medical and dental knowledge, more focus on the development of skills and attitudes. Without a doubt, to ensure dentists’ competencies, clinical skills should be taught and assessed accordingly. Performance assessment, including the Objective Structured Clinical Examination (OSCE), has been used globally for assessing a dental student’s stage of development for years. Many studies have concluded that by using OSCE, clinical instructors are able to understand students’ clinical competencies better than by the written examination. OSCE, lately becoming a part of Licensure examination in North America and Japan, has been widely recognized as an important tool for assessing clinical skills. It includes a national standardized assessment of clinical competencies such as patient-physician communication, clinical history taking and clinical examination skills.
To promote quality of dental education, School of Dentistry, National Taiwan University established an OSCE study group which works on guideline development and faculty training. Through the information collection and literature review, our comparison of the core competencies of dentistry of five countries came to similar conclusions in a number of areas; however, they varied in other areas, which may due to cultural differences. We built up the blueprint of OSCE by employing the Nominal Group Technique to identify the essential core competencies required of dental students prior to graduation. After a series of faculty training and reliability in performance assessment through mini-OSCE, the examination guideline was set up. Finally, we held the 6 stations of OSCE for 36 students from 3 different levels. The results of OSCE may help clinical faculties to formulate their teaching content and to modify their teaching skills. We also hope that the guideline we developed for the implementation of OSCE will act as a reference when dental schools perform OSCE in the future.

Keyword : Performance assessment, Objective Structured Clinical Examination, Nominal Group Technique


口試委員會審定書 i
誌謝 ii
中文摘要 iii
英文摘要 iv
第一章:導論 1
1.1 緣起 1
1.2 國內外牙醫學教育制度 3
1.3 國內外牙醫師檢定與執照核發制度 5
1.4 各國牙醫畢業生需具備之臨床核心能力 7
1.5 我國牙醫畢業生需具備之臨床核心能力在地化之考量 8
1.6 考官訓練與臨床實作評量結果之信度關係 9
第二章:研究目的 10
第三章:實驗材料與方法 12
3.1 探討各國牙醫學畢業生核心能力訂定之異同 12
3.1.1 研究對象 12
3.1.2 研究步驟 12
3.2 我國牙醫學畢業生核心能力之訂定 13
3.2.1 研究對象 13
3.2.2 研究步驟 13
3.2.3 資料分析 14
3.3 考官訓練與臨床實作評量結果之信度關係 15
3.3.1 總論 15
3.3.2 研究對象 15
3.3.3 研究步驟 15
3.3.4 資料分析 16
3.4 牙醫OSCE考試之執行 17
3.4.1 總論 17
3.4.2 研究對象 17
3.4.3 研究方法 18
3.4.4 資料分析 18
第四章:實驗結果 20
4.1 各國牙醫學畢業生核心能力訂定之異同 20
4.2 我國牙醫學畢業生核心能力之訂定 21
4.2.1 基本資料 21
4.2.2 投票結果 21
4.3 考官訓練與臨床實作評量結果之信度關係 23
4.4 牙醫OSCE之執行 24
第五章:討論 25
5.1 研究各國牙醫學畢業生核心能力訂定之異同的重要性 25
5.2 我國牙醫學畢業生核心能力之訂定 27
5.3 考官訓練與臨床實作評量結果之信度關係 29
5.4 牙醫OSCE考試之執行 31
第六章:結論 36
第七章:未來研究努力方向 38
第八章:圖目錄 39
第九章:表目錄 55
參考文獻 69
附 錄 74
附錄 I 74
附錄 II 91


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