迷你临床演练评量mini-Clinical Evaluation Exercise.pptVIP

迷你臨床演練評量mini-Clinical Evaluation Exercise 葉建宏 新光吳火獅紀念醫院神經科　主治醫師 臺灣大學 / 輔仁大學醫學院　助理教授 mini-CEX 什麼是mini-CEX? 如何正確評量mini-CEX? 如何正面回饋mini-CEX? 如何實施mini-CEX? 教學評量 Administration database Medical record audits Diary, logbook, passport Direct observation; Mini-CEX SP/OSCE Model, Simulation Oral examination Computerized patient simulations Patient management question Essay question Multiple-choice question Direct Observation during Clerkship – U of Virginia 迷你臨床演練評量mini-Clinical Evaluation Exercise (mini-CEX) 什麼是 Mini-CEX? Clinical evaluation exercise (CEX) Observes a resident perform a complete history and PE on a single patient, and give an oral presentation of pertinent data and a management plan Takes approximately two hours Limitations Unreliability of the observer Variation of resident performance Artificiality of the task (not real-world practice) 迷你臨床演練評量mini-Clinical Evaluation Exercise 美國內科醫學會發展推薦的評量工具 已於21所醫院進行前導研究，頗獲好評 可行性高，教師學員皆認同 信效度優於傳統評量方法 可適用於醫學生 Mini-CEX 流程 老師直接觀察學員(住院醫師)在病人身上執行例行診療行為 評估項目：醫療面談，身體檢查，人道專業，臨床判斷，諮商衛教，組織效能等6項並加以回饋 耗時：觀察診療行為(15-20分鐘); 回饋與評量(5-10分鐘) 由學員找老師應試 每年需完成6次評量 評量表單一 直接觀察學生執行重點式的診療工作 評量表單二 臨床教師依七種項目評量學員之稱職能力 評量表單三 提供學員教育性回饋 如何正確評量mini-CEX? 評量項目:醫療面談 鼓勵病人說故事 有效的利用問題或導引來獲的所需之正確而足夠的訊息 對病人之情緒及肢體語言能適當的回應 參考資料:醫療面談 Starts with open-ended questions Progresses with specific questions Does not ask multiple questions Does not ask presumptive/leading questions Asks for clarification if necessary Logical sequencing of questions Segment summary 評量項目:身體檢查 依效率及合理之次序 依病情均衡地操作篩選或診斷之步驟 告知檢查事項 適當而審慎地處理病人之不適 參考資料:身體檢查 Washes hands Minimizes discomfort Preserves modesty Explains to parent what doing Explains to child what doing Sequence matches cooperation level Builds rapport Correct technique 評量項目:人道專業 表現尊重、 憐憫、 感同身受 建立信賴感 處理病人對舒適、受尊重、守密渴望訊息的需求 參考資料:人道專業 My doctor seems to take a personal interest in me. Even when my problem is small, my doctor is concerned. I have confidence in my doctor’s decisions. My doctor respects my beliefs. I’d talk to my doct