臺灣博碩士論文加值系統

背景：客觀結構式臨床測驗（Objective Structured Clinical Examination, OSCE）之目的在於評量有別於傳統筆試所無法測驗之面向。Mini-Clinical Examination（Mini-CEX）則是一種廣為世界採用之醫學教育迷你臨床測驗評估量表。標準化病人是OSCE的一大特色，然而目前評估的量表稍嫌複雜。
目的：我們想要探討及發展具有迷你臨床測驗概念又適合國內民情及醫學教育需求的量表，可以針對標準化病人及標準化病人訓練師的訓練、評估及考核都能適用的迷你評估表。
方法：我們主要使用焦點團體法提名因素項目，進一步討論命名、歸納或刪除項目因子；預評之後會再進行項目分析，並以因素分析（Factor analysis）的主成分分析法（Principal Component Analysis）釐清重要性，經過信度與效度的分析與探討建立正式量表。正式量表再經過多次的施測，評定驗證量表的信度與效度。
結果：實際運用標準化病人評分量表來評估所有標準化病人的表現， Cronbach α 值為 0.982。標準化病人訓練師評分量表Cronbach α 值則為 0.919。用Pearson correlation 的方法檢定兩個量表所有評核項目兩兩之間彼此的相關性，都可以達到統計學上P<0.01非常顯著的意義。用主成份法的方法來進行標準化病人迷你評分量表各因素的因子分析所得到的各項因素重要性分析平均都在0.9以上。
結論：本研究發展一個以新思維創新卻簡易方便的評估量表來評核標準化病人之訓練與演出，讓從事訓練標準化病人之標準化病人訓練師，無論是否有醫療背景，均能輕易上手，方便標準化病人的訓練與評估。

Background:
Objective Structured Clinical Examination (OSCE) aims to test the medical students in the domains different from the traditional exams. Mini-Clinical Examination (Mini-CEX) is one popular and convenient tool to assess the medical clinical skills. Standardized patients (SPs) are one characteristic of the OSCE but the current format is complicated to evaluate their performance.
Objective:
We wanted to develop simple and feasible tools to evaluate the performance of SPs and standardized patient trainer (SPT) for the purposes of training and assessment inspired by the convenience of mini-CEX.
Methods:
We developed and nominated the items of the scales by the focus group method and tested the reliability by Cronbach α and the validation by the factor analysis. All statistics were analyzed by SPSS 12.0 and defined the significance by P<0.05.
Result:
The Cronbach α of the scales to assess SPs and SPTs were 0.982 and 0.919. Both scales showed significant by Pearson correlation (P<0.01). The factor analysis showed good validity of the scale to check SPs by principle component method.
Conclusion:
We developed and demonstrated convenient and feasible tools to assess the SPs and SPTs with good reliability and validity to improve the training and education.

口試委員會審定書 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯ 3
誌 謝 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯4
中文摘要 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯5
英文摘要 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯6
第一章 緒論
第一節 台灣醫學教育背景回顧與改革 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯7
第二節 研究動機 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯ 8
第二章 文獻回顧與探討
第一節 標準化病人的起源與發展 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯11
第二節 國內標準化病人的起源與發展 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯13
第三節 標準化病人的評估 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯15
第四節 標準化病人訓練師的角色與重要性 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯17
第五節 由迷你臨床測驗得到的啟發⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯19
第三章 研究方法
第一節 研究目的與方法 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯20
第二節 研究架構與步驟 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯21
第四章 研究結果
第一節 標準化病人演出的核心能力與評估工具開發 ⋯⋯⋯⋯⋯32
第二節 標準化病人訓練師的核心能力與評估工具開發 ⋯⋯⋯⋯37

第五章 討論
第一節 標準化病人演出的核心能力與評估工具開發⋯⋯⋯⋯⋯⋯41
第二節 標準化病人訓練師的核心能力與評估工具開發 ⋯⋯⋯⋯43
第三節 質性分析探討：標準化病人訓練師小組演練評核表 ⋯44
第四節 以成人學習理論探討標準化病人的學習 ⋯⋯⋯⋯⋯⋯⋯⋯52
第五節 回 饋 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯53
第六節 研究限制 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯56
第六章 結論⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯57
參 考 文 獻 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯59
附 錄 ⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯⋯62

1.Krugman P.: Pride, Prejudice, Insurance. The New York Times. Nov. 7, 2005.
2.台灣醫療亞洲第一全球第三. https://chaoglobalwordpresscom/2014/09/17/taiwan-medical-tech/.
3.臺灣醫療介紹：臺灣國際醫療全球資訊網 Oct. 29, 2014. http://www.medicaltravel.org.tw/Article.aspx?a=17&l=1.
4.黃伯超：百年基礎醫學發展史. 傳承與轉型:中華民國發展史論文研討會. Jan.28-29, 2011:625-650.
5.Harden R., Stevenson M., Downie W., Wilson G.: Assessment of Clinical Competence using Objective Structured Examination. Medical Education 1975, 1:447-451.
6.蔡詩力、陳震寰、方基存、蔡景仁、張上淳：客觀結構式臨床測驗(OSCE)執行指引. 醫學教育 2008, 12:118-132.
7.Zyromski N., Staren E., and Merrick H.: Surgery residents perception of the objective structured clinical examination (OSCE). Current Surgery 2003, 60(5):533-537.
8.Pierre R., Wierenga A., Barton M., Branday M. and Christie C.: Student evaluation of an OSCE in paediatrics at the University of the West Indies, Jamaica. BMC medical education 2004, 4:22.
9.陸希平、葉建宏、侯勝茂、駱惠銘、邱浩彰：回饋理論在醫學教育的應用. 臺灣醫學 2012, 16(6):667-675.
10.Tsai S-L., ChenY-Y., Chu T-S., Chiu H-C., Kao M-C. & Yang P-C.：A Comparison of Standard-Setting Methods in Taiwan’s Nationwide Objective Structured Clinical Examination. Journal of Medical Education 2013, 17:21-29.
11.曾慧敏、劉克明：高階客觀結構式臨床測驗在國家考試的應用與展望. 國家菁英 2010, 6:3 (23 ):111-129.
12.Norcini J., Blank L., Duffy D., and Fortna G.: The Mini-CEX：A Method for Assessing Clinical Skills. Ann Intern Med 2003, 138:476-481.
13.Barrows H.: An overview of the uses of standardized patients for teaching and evaluating clinical skills. Academic medicine : journal of the Association of American Medical Colleges 1993, 68:443-453.
14.Barrows H. and Abrahamson S.: The programmed patient: a technique for appraising student performance in clinical neurology. J Med Educ 1964, 39(39): 802-805.
15.Wallace P.：Following the Threads of an Innovation: The History of Standardized Patients in Medical Education. Standardized Patients in Medical Education 1997, 13(2): 5-28.
16.Collins J.P. and Harden R.: AMEE Medical Education Guide No.13: real patients, simulated patients and simulators in clinical exainations. Medical teacher 2009, 20(6): 508-521.
17.蔡詩力、楊志偉、葉啟娟、張上淳：標準化病人的招募與訓練：台大醫院的經驗. 醫學教育 2007, 11: 174-181.
18.Wind L., Dallen J., Muijtjens A.& Rethans J-J.: Assessing simulated patients in an educational setting: the MaSP (Maastricht Assessment of Simulated Patients). Medical Education 2004, 38: 39-44.
19.Bouter S., Weel-Baumgarten E., and Bolhui S.: Construction and Validation of the Nijmegen Evaluation of the Simulated Patient (NESP): Assessing Simulated Patients’Ability to Role-Play and Provide Feedback to Students. Academic Medicine 2013, 88: 253–259.
20.Furman G.: The Role of Standardized Patient and Trainer Training in Quality Assurance for a High-stakes Clinical Skills Examination. Kaohsiung J Med Sci 2008, 24:651-655.
21.陳偉德：迷你臨床演練評量(mini-CEX). 醫療品質雜誌 2007, 1(4): 77-81.
22.陳偉德、蔡長海、黃崑巖：臨床醫學教育與Mini-CEX. 醫學教育 2005 9(4): 74-81.
23.Krueger R. and Casey M.: Focus Groups: A Practical Guide for Applied Research. Thousand Oaks, CA: Sage 2000, 3rd ed.
24.How To Develop Leadership Skills. http://faqhowcom/how-to/how-to-develop-leadership-skills.
25.成人學習教育. 1995：成人教育學會編.
26.Merriam. D.: Adult education: Foundation of Practice. 1982.
27.許義雄：兒童發展與身體教育. 1997,國立編譯館主譯。麥克羅，希爾印行.
28.Bokken L., Linssen T., Scherpbier A., Vleuten C. & Rethans J-J.: Feedback by simulated patients in undergraduate medical education: a systematic review of the literature. Medical Education 2009, 43: 202-210.
29.Pfeiffer C.A., Kosowicz L.,Y. Holmboe E., Wang Y.: Face-to-face clinical skills feedback: lessons from the analysis of standardised patients'' work. Teaching and learning in medicine 2005, 17(3): 254-256.
30.Harter S.: A model of intrinsic mastery motivation in children：Individual differences and developmental change. Minnesota symposium on child Psychology 1981, 14:215-255.
31.Schunk D.H.: Progress self-monitoring: Effects on children’s self-efficacy and achievement. . Effects on children’s self-efficacy and achievement Journal of Experimental Education 1983, 51: 89-93.
32.Sage, G.H.: Motor learning and control : Neuropsychological approach. Iowa: Brown & Benchmark Publishers 1984.
33.張春興、林清山：教育心理學. 1989, 台北：東華書局.
34.Nestel D. and Bearman M.: Learning theories and simulated patient methodology. Simulated Patient Methodology: Theory, Evidence and Practice 21 Nov., 2014.
35.Kolb D.: The Learning Style Inventory: Technical Manual. McBer & Co, Boston, MA 1976.