101 OSCE 102 1

... 1... 4 (OSCE)... 160 OSCE... 275... 281

序 e OSCE 101 9 21 OSCE OSCE Objective Structured Clinical Examination; OSCE objectivestructuredclinical examination 102 7 OSCE OSCE

102 1

壹 開 幕 致 詞 一 關 中 考 試 院 院 長 OSCE OSCE OSCE OSCE 1,000 2013 OSCE OSCE 二 董 保 城 考 選 部 部 長 90% 1

OSCE OSCE OSCE OSCE 2

OSCE OSCE OSCE 3

貳 第 一 場 次 專 題 研 討 OSCE 101 9 21 9 30 1 1 OSCE 一 主 持 人 致 詞 100% 95% 98 100 101 4

102 OSCE OSCE OSCE 二 傅 教 授 立 志 報 告 ( 詳 如 書 面 資 料 及 投 影 片 資 料 ) 34 3 2005 6 2,109 2,405 56 300 92 97 194 158 8 158 18% 300 18 2 PGY PGY2 2 7 7 6 5

5 1/3 43% 52% Dentsim Dentsim 300 9697 total patient care 99 7 ACGME patient care simulation system self learningself correcting professionalismsystem-based practice 6

OSCE OSCE OSCE 6 2 5 25 2 OSCE 93 7 93 ready OK x-ray database loading monitor X combine ready to go case station x-ray organize structure ready 7

OSCE morning afternoon station OSCE EXAM Non-Patient Based X 15 part2 4 component 4 3 OSCEDiagnosis and Treatmnet Planning exammedical Emergencies Exam Dental Manikin OSCE OSCE Michigan D4 D3 OSCE ADA alternative models to the clinical licensure exam Canadian Examination-Non-Patient Based OSCE 2010 Non-Patient Based OSCE Discussion of possible treatment options l 25 Fiona 7 consultation station available options option information gathering pressure history taking case 5 2 7 5 demend 8

三 顏 教 授 宏 融 報 告 ( 詳 如 書 面 資 料 及 投 影 片 資 料 ) 101 3 OSCE 10 OSCE OSCE OSCE 11 PGY Mini-CEX DOPs 2 OSCE OSCE 1617 OSCE OSCE OSCE 1975 2009 OSCE 9

102 OSCE 2 101 OSCE OSCE 101 2 101 3 OSCE 101 3 24 41 6 2 12 4 1 2 12 1 2 OSCE 2 OSCE OSCE OSCE OSCE DVDDVD check list DVD 10

OSCE OSCE 80 OSCE 6 OSCE OSCE 101 3 OSCE OSCE OSCE list inter-rater analysis 6 8 inter-rater analysis 11

inter-rater analysis Kendall s W Cronbach s alpha 80 OSCE X OSCE 6 Cronbach s alpha 6 12 41 OSCE 12

8 2 12 3 19 X 160 101 global rating 600 477 13

OSCE OSCE 2 Mini-CEX DOPS OSCE 101 10 20 OSCE 102 OSCE OSCE OSCE OSCE OSCE 四 林 教 授 俊 彬 與 談 ( 詳 如 書 面 資 料 及 投 影 片 資 料 ) learning pyramid performance doing knowledge knowledge knows how competence show how performanceperformance behavior performance OSCE performance do 14

actionaction Mini-CEX DOPs Performance action OSCE DOPsMini-CEX 7 training crown program show behavior process replay play 3 70 69.5 OSCE OSCE OSCE OSCE OSCE 15

OSCE team OSCE 7 OSCE 6 2 OSCE 5 2 PGY 五 洪 教 授 純 正 與 談 ( 詳 如 書 面 資 料 及 投 影 片 資 料 ) 30% Manikin 2006 simulator Kavo 60 95 16

9 7 2005 Dentsim 300 5 1 5 Kavo 95 Dentsim 30 OSCE2/3 2/3 1/3 OSCE 5 24 Dentsim 200 60 6 support simulation 5 5 final2011 simulation 8 Dentsim system 3 system Nissin Nissin 17

六 主 持 人 高 考 試 委 員 明 見 Dentsim 1/3 OSCE 七 蘇 教 授 奕 彰 與 談 ( 詳 如 書 面 資 料 及 投 影 片 資 料 ) 1912 1958 OSCE OSCE 50 8 5 7 42 100 102 101 102 6 2 1990 7 5 18

8 9 6 2005 TMAC PBL OSCE 220 OSCE PBL 10% 99 101 OSCE 19

OSCE 八 謝 助 理 教 授 明 儒 與 談 ( 詳 如 書 面 資 料 ) OSCE OSCE OSCE OSCE OSCE OSCE OSCE ACGME 96 80 20

OSCE OSCE checklist OSCE OSCE OSCE OSCE 九 王 副 處 長 宗 曦 與 談 ( 詳 如 書 面 資 料 ) OSCE OSCE OSCE 13 13 13 21

13 license PGY 13 13 13 PGY 3,500 102 OSCE OSCE OSCE 100 9 3 22

OSCE OSCE OSCE OSCE OSCE OSCE OSCE OSCE 1 5 OSCE OSCE OSCEDOPsmini-CEX 1,300 99 236 295 1,012 8,551 13 十 主 持 人 高 考 試 委 員 明 見 23

十 一 綜 合 討 論 PGY 5+2 24

OSCE OSCE OSCE OSCE slogan OSCE OSCE OSCE 5,700 25

skill attitude OSCE support OSCE OSCE OSCE OSCE OSCE 26

OSCE OSCE OSCE OSCE OSCE OSCE OSCE OSCE OSCE 102 4 4 102 OSCE 27

十 二 主 持 人 結 語 7 OSCE OSCE OSCE 7 4 OSCE 28

OSCE 1 10 3 3 1.5% 2% (1) (2) (3) 1 29

101 ACGME 4+4 6+2 5+2 ACGME 92 ~98 91 ~ 92 197 298 6 101 7 99 12 6 9 91 99 419 30

20128 2011 09 01 0.9 69% 2025 31

30% 15% 7 6 43% 52% Integrative Learning PDCA 92 11 93 32

95 virtual reality-based technologydentsim DentSim traditional methodologyconsistent unbiasedfeedback 1~2 6 1 vocational training5 2 vocational training4 1 4 1 vocational training 18 2 180 99 patient-centeredcomprehensive dental treatment 101 4 14 OSCE 33

1975 Dundee University Dr. RM Harden Objective Structured Clinical Examination, OSCE OSCE University of Michigan R ga Stradi š University e 131 OSCE OSCE 96 9 12 OSCE OSCE OSCE e Objective Structured Clinical Examination, OSCE Case Based Learning-CBL OSCE OSCE OSCE OSCE OSCE OSCE OSCE 1 1. ObjectiveStandardized Checklist 2. Structured 3. ClinicalStandardized Case 4. Examination OSCE 34

OSCE Google OSCE in dentistry 299,000 88 G BrownM Manogue M MartinQueen's Medical Centre, Nottingham, UK. OSCE validity and reliability 7 OSCE patient-centeredcomprehensive dental treatment OSCE 1. 2. OSCE 3. 5+2 OSCE 35

4. OSCE 5. OSCE OSCE 1. OSCE 2 6 6 OSCE 36

5+2 OSCE 2. General DataChief ComplaintPast Medical HistoryPast Dental HistoryPersonal HabitExtra-oral findingintra-oral findingstudy Cast Panoramic film Periapical Films OSCE 11 37

38

2005 93 ( 389) 30 84 77 13 11 1: 8 240 42 180 218 30 30 1: 6 256 46 457 504 85 10 1: 29 254 21092962405 47 456 555 87 17 1: 36 238 49 477 501 80 25 1: 19 240 65 231 251 45 22 1: 10 241 69 224 299 49 10 1: 22 254 39

40

41

42

43

44

(ACGME) --- (Patient care) (Medical knowledge) () (Practice-based learning and improving) (Interpersonal and communication skills) (Professionalism) (System-based practice) 45

OSCE OSCE 行 -OSCE OSCE 理 行 46

6 osce Undergraduate U1 U2 U3 U4 U5 U6 (Intern) Postgraduate Specialty PGY-1 PGY-2 G1 G2--- 47

osce Undergraduate Postgraduate Specialty U1 U2 U3 U4 U5 PGY-1 PGY-2 G1 G2--- 48

49

50

51

52

53

Conclusion: The present study showed a positive effect of an additional training unit on students performance in the OSCE. Taking the limitations of the study and the results of a literature review into account, we recommend conducting such training as preparation for the OSCE. 54

55

56

57

58

59

60

61

62

1 101 3 24 Objective Structured Clinical Examination, OSCE 1 63

101 3 24 Objective Structured Clinical Examination, OSCE OSCE WHO 2002 55 80 2002-2005 64

91 97 98 101 Miller's Prism of Clinical Competence OSCE OSCE Oobjective S structured Cclinical Eexamination 1975 Dundee University Dr. Ronald Harden OSCE Standardized Patients, SP 1992 1997 ECFMG2004 65

USMLE2009 2011 OSCE 2013 OSCE 101 7 1 OSCE knowledgeattitudesskills Miller's Prism of Clinical Competenceknowsknows howshows dose 47 55 73 87 99 101 66

1 2012-02-21 1-2 2 Communication skills and application of History taking of Chinese medicine. 2 2012-02-28 1-2 2 3 2012-03-06 1-2 2 Communication skills and application of History taking of Chinese medicine. 4 2012-03-13 1-2 2 Medicine identification techniques 1. 5 2012-03-20 1-2 2 Medicine identification techniques 2. 6 2012-03-27 1-2 2 Points and examination notes of Traditional Chinese pediatric medicine. 7 2012-04-03 1-2 2 Semester course introduces and medical writing skills. 8 2012-04-10 1-2 2 Points and examination notes of Traditional Chinese gynecology medicine 9 2012-04-17 1-2 2 Cupping techniques and applications. 67

10 2012-04-24 1-2 2 Basal body temperature measurement and interpretation. 11 2012-05-01 1-2 2 Acupuncture exercise apparatus production and application. 12 2012-05-08 1-2 2 Needle insertion techniques and applications. 13 2012-05-15 1-2 2 Splint production and application. 14 2012-05-22 1-2 2 Orthopedic examination techniques and applications. 15 2012-05-29 1-2 2 Throat, eye and oral examination of TCM. 16 2012-06-05 1-2 2 Ru Yi Jin Huang paste production techniques and applications. 17 2012-06-12 1-2 2 Basic trauma techniques and application. 18 2012-06-19 1-2 2 DVD 2 68

69

OSCE 12 70

OSCE 99 OSCE 101 3 24 OSCE OSCE OSCE 1 OSCE OSCE OSCE 71

2 OSCE 1 1. OSCE 2. 2 3 4 1. 2. 5 SP 6 SP 7 8 1. SP 2. 1. 2. 3. 9 10 11 1. 2. 12 72

13 SP 14 15 41 OSCE 12 OSCE 4 OSCE 2 OSCE 4 10 2 100 OSCE Inter-rater analysis Kendall's W 0.722Cronbach's alpha 0.947 6 12 12 12 24 1-6 7-12 OSCE OSCE DVD 73

Cohen Kappa DVD Cohen Kappa checklist global rating SP 1 8 18-30 2 8 20-30 3 8 20-30 4 8 30-50 5 8 20-50 6 8 20-50 6 6 1-6 7-12 74

OSCE OSCE OSCE 08:40-09:00 20 09:00-09:10 10 09:10-10:00 OSCE 10:10-11:00 OSCE 50 11:10-:12:00-50 50 8F 12:00-13:00 60 13:00-17:50 13:00-13:50 A B C D 14:00-15:50 D A B C 16:00-16:50 C D A B 150 4 1 2 B1 17:00-17:50 B C D A 17:50-18:10 30 8F OSCE OSCE 75

OSCE OSCE OSCE OSCE OSCE 1. OSCE 2. OSCE 3. OSCE 4. OSCE 5. 6. OSCE 12 76

101 3 17 OSCE 41 1.OSCE 4 2.OSCE 2 3.OSCE 4 Interrater analysis Kendall's W 0.722Cronbach's alpha 0.947 OSCE 101 4 17 80 77

OSCE OSCE OSCE 2012 3 9 2012 3 9 3 13 ( ) ( ) 2 100 2012 3 24 L 78

2012 A B C D 瀞 嫺 瀞 79

2012 2012 3 24 100 1 4 6 1 20 10 2 8 ❶ ❷ 0745 ~ 0845 1H A 0815 ~ 0835 20M A B C D A 0835 ~ 0845 10M ❶ A 0845 ~ 0945 1H B 0915 ~ 0930 15M ❷ C.D B 0930 ~ 0950 20M ❷ ❷ 0945 ~ 1000 15 M ❶ ❷ ❷ ❷ B C.D 1000 ~ 1100 1H ❷ ❷ 1100 ~ 1115 15 M ❶ ❷ ❷ C 1115 ~ 1215 1H ❷ 1215 ~ 1300 45 M ❶ ❷ D 1300 ~ 1400 1H 1400 ~ ❶ 80

2012 1. 2. 3. 4. 81

82

2012 2012 03 24 2 1 2. 83

84

85

86

87

88

89

90

91

92

93

94

95

96

97

98

99

100

101

102

103

104

105

106

OSCE 1 Institute of Medicine 1999 To err is humanbuilding A Safer Health System Institute of Medicine simulation simulationstandardized patient screen-based simulationpart-task trainer human patient simulator high-fidelity simulation virtual reality human patient simulator 1 107

1. human patient simulator 2. 3. 4. 5. 6. Miller Practice by doing 75 OSCE OSCE OSCE 12 8 OSCE OSCE 100 9 17 11 19 OSCE 108

OSCE OSCE OSCE OSCE OSCE ODEndoPerioProsthetic 109

Service Research 2012.09.21 The Learning Pyramid National Training Laborator ies, Bethel, Maine, USA Lecture Reading Audiovisual Demonstration Discussion group Practice by doing Teach others Average Retention Rate 5% 10% 20% 30% 50% 75% 80% 110

Performance tests in vivo: Performance tests in vitro: Clinical (context based tests) Factual/comp. tests Action Does Performance Shows how Competence Knows how Knowledge Knows Mini-CEX, DOPs, Portfolios, 360o OSCEs, Manniquin SP-based test.. MCQs, essays, oral tests, Short answers... MCQs, essays, Short answers,. Miller GE. The assessment of clinic al skills/competence/performance. Academic Medicine (Supplement) 1990; 65: S63-S67. 1. 2. 3. 4. 5. 6. 111

Computerized Dental Simulator Professional operation training 1. Lesson lecture 2. Patient information 3. X-ray 4. Tooth diagram 5. Course information Crown Cavity Endo Pedo., Oral Diagnosis, Oral Surgery etc. Computerized Dental Simulator 112

Computerized Dental Simulator (CDS-100) Evaluation Wall angles -1 1. 10091711 19 OSCE 2. OSCE OSCE 113

-2 3. OSCE OSCE 4. -3 5. ODEndo PerioProsthetic 114

-4 6. 目 前 之 困 境 及 具 體 建 議 -1 制 度 面 相 ( 困 境 ): 目 前 牙 醫 學 系 學 制 是 否 需 修 改 尚 無 定 案, 因 而 臨 床 技 能 測 驗 也 無 法 確 定 牙 醫 學 系 學 生 應 何 時 應 考 制 度 面 相 ( 具 體 建 議 ): 比 照 目 前 國 內 醫 學 教 育 規 劃 (6+2) 而 言,5+2 為 牙 醫 學 教 育 較 能 接 受 且 阻 力 最 少 之 方 案 若 以 此 規 劃, 則 可 將 臨 床 技 能 測 驗 分 成 兩 階 段, 第 一 階 段 為 學 生 進 入 臨 床 的 實 習 課 程 之 前, 第 二 階 段 則 定 為 二 年 期 牙 醫 師 畢 業 後 一 般 醫 學 訓 練 (PGYD) 結 束 後 林 俊 彬 臺 大 牙 醫 專 業 學 院 115

-2 () () (.. )( ) -3 () ( ) () 116

Service Research 2012.09.21 117

OSCE 1 DentSim DentSim 300 26 DentSim DentSim DentSim 1 118

DentSim Kavo Kavo Nissin 30 60 Kavo 94 100 Kavo 119

Kavo 1. OSCE 2. 3. OSCE 4. CDS-100 Kavo 120

121

122

123

124

125

126

127

128

129

130

1 OSCE OSCE 443 1958 1958-1965 19661984 1990-2000 1995-2002 1 131

2003-2005 PBLPBT SARS 2006-2011 OSCEMini-CEXDOPS TMAC Abraham Flexner H.S. BarrowsRonald HardenDavid Irby OSCE 1998 20102012 132

360 OSCE 5,500 10% OSCE 220 OSCE 30% 3.9% OSCE OSCE 102 Outcome Base 1-2 OSCE 133

134

135

136

137

138

139

140

141

142

143

144

145

146

147

148

149

150

151

OSCE 1 Clinical Competence Objective Structured Clinical Examination, OSCE OSCE OSCE OSCE OSCE Objective Structured Clinical Examination, OSCE OSCE 2010 OSCE OSCE OSCE OSCE OSCE Formative OSCE High stake 1 152

Summative OSCE OSCE OSCE OSCE OSCE OSCE OSCE 8 OSCE OSCE 12 OSCE OSCE OSCE OSCE OSCE 153

OSCE Standardized Patient, SP SP SP SP 2011/03/08 OSCE OSCE OSCE USMLE Step II OSCE OSCE PGY OSCE 6,000 8,000 OSCE 154

OSCE OSCE OSCE OSCE OSCE OSCE OSCE OSCE OSCE 155

156

157

158

159

參 第 二 場 次 專 題 研 討 OSCE 101 9 21 2 1 1 OSCE 一 主 持 人 致 詞 40% 30% 40% 20% 60 300 10 50 60 10 prerequisite 160

OSCE 二 林 助 理 教 授 香 汶 報 告 ( 詳 如 書 面 資 料 及 投 影 片 資 料 ) 4 6 OSCE NEPLEX computerized adaptive GRE PGY residency 2008 130 OSCE OSCE open book OSCE subject 161

70 attitude skill patient care 50%OSCE 26% communication skill OSCE communication skill NEPLEX 90% 90% 2001 2011 range 70-90% 30% 8 30% 35-36% 8 74% 61% 36% 57% OSCE 90% 162

disclosure OSCE 1 4 6 2006 2007 8 2002 2012 DOPS Mini-CEX OSCE PGY OSCE OSCE OSCE 2008 OSCE OSCE OSCE 80%OSCE 163

OSCE OSCE OSCE OSCE SWOT 30 practice OSCE 2008 OSCE DOPS Mini-CEX PGY OSCE PGY P0P1P2P3P4 TFDA OSCE OSCE OSCE OSCE PBL 4 101 4 OSCE OSCE 4 OSCE 3 OSCE 40 116 OSCE advance 2007 2009 164

case OSCE OSCE OSCE SWOT level range example 4 PBL OSCE rater 0.186 OSCE OSCE 90% OSCE 70% 2004 OSCE SWOT DOPsMini- CEXOSCE OSCE 165

6 OSCE OSCE loading advanced OSCE 14 RPSGB ACP 30 2005 OSCE 3 三 周 主 任 月 卿 與 談 ( 詳 如 書 面 資 料 及 投 影 片 資 料 ) 2010 8 2007 2007 8 166

Drug Related Problem Drug needed Drug not prescribed, patient nonadherence Drug needed Wrong or inappropriate drug Without indication, polypharmacy contraindication etc. Wrong or inappropriate drug indication contraindication Wrong dose Prescribed dose too high or too low Correct prescribed dose but overadherence or underadherence overadherence or underadherence Adverse drug reactions Hypersentivity or Idiosyncratic reaction Drug induced diseaseor laboratory change Drug interaction Drug-drugfood, laboratory test, disease Medication Therapy Management, MTM medication therapy review, MTR personal medication record, PMR medication-related action plan, MAP DRPs 167

DRPs intervention referral drug therapy monitoring, DTM medication reconciliation documentationfollow-up usual dose overdose underuse 2012 170 7 12.5% 62 90 60 16% OSCE Miller's OSCE OSCE 14 OSCE 6 5 4 4 168

OSCE OSCE 14 1 Patient care 6% 2 Professional collaboration and team work 9.5% 3 Ethical, legal and professional responsibilities 9.5% 4 Drug, therapeutic and practice information 5% 5 Communication and education 38% 6 Drug distribution 9.5% 7 Understanding management principles 2.5% OSCE 6 1 來 應 對 2 藥 剤 の 3 剤 4 実 践 5 OSCE OSCE OSCE 5 1 Medication knowledge and counseling 2 Primary healthcare 3 Legal and ethical practice 4 Problem solving & communication Problem solving 169

OSCE 4 1 Practice pharmacy in a professional manner 2 Contribute to the quality use of medicine 3 Primary health care 4 Provide information 5 Dispense medicines Dispense 4 OSCE table OSCE OSCE OSCE OSCE PBL OSCE 3 PBL 5 OSCE 2006 102 67 2009 2015 OSCE OSCE 8 16 1.9 2.4 1.2 1.5 四 王 主 任 春 玉 與 談 ( 詳 如 書 面 資 料 ) OSCE PGY OSCE OSCE center 170

center practice practice OSCE skill performance test 4 5 6 80% practice skill 80% OSCE PGY PGY PGY 40%PGY PGY PGY 80% PGY PGY practice 20% OSCE PGY 3040 PGY 8090 90 5060 五 鄒 組 長 玫 君 與 談 ( 詳 如 書 面 資 料 ) OSCE 171

4 6 TFD OSCE TFD 六 主 持 人 胡 考 試 委 員 幼 圃 20032004 OSCE OSCE OSCE OSCE OSCE OSCE OSCE OSCE OSCE 90 60 172

job training 七 綜 合 討 論 ( ) 80 100 OSCE 8 4 20 OSCE PGY 173

( ) OSCE OSCE 6 ( ) OSCE ( ) OSCE 20% OSCE OSCE ( ) ( ) 20% 174

20% ( ) OSCE OSCE OSCE ( ) 30% 2/3 1/3 OSCE 1993 175

( ) OSCE OSCE OSCE ( ) OSCE performance performance OSCE 176

OSCE OSCE APEC OSCE ( ) OSCE 177

747 OSCE OSCE ( ) OSCE ( ) fitness practice OSCE OSCE 178

OSCE OSCE 60 OSCE OSCE 30 15 OSCE OSCE OSCE OSCE OSCE OSCE 179

30 OSCE OSCE OSCE ( ) OSCE ( ) OSCE OSCE ( ) 180

( ) OSCE OSCE OSCE OSCE OSCE OSCE OSCE OSCE OSCE OSCE 八 主 持 人 結 語 OSCE OSCE 181

OSCE 1 Objective Structure Clinical Examination, OSCE 2011 4 5 1,056 OSCE 2015 OSCE 2016 OSCE OSCE OSCE 2006 OSCE 2001 OSCE OSCE OSCE 1 182

OSCE OSCE OSCE OSCE OSCE SWOT 98 1 2 3 1 183

1 2 2 2006 Objective Structured Clinical Examination, OSCE OSCE OSCE OSCE 3-5 OSCE OSCE 123 45 6 6 2012 7 184

453 86 2 15 7 2007 8 8,7 7 OSCE 2006 2009 2011 4 5 1,056 OSCE 2015 OSCE 2016 OSCE 9 2011 8 27 28 2012 2 16 17 10 2012 8 27 28 130 1 185

OSCE OSCE OSCE SWOT 2009 6 2009 2010 9198 98100 2006 OSCE 15%99 63% 3.8% 4% OECDorganization for economic cooperation and development 1.8% 102 OECD 76 1.821 41 11 99 23,162 6,839 80.16% 18.38% 1.41% 186

28% 33% 38% 12 13 135 36 5 12 7.8 15.8 1.9 2.4 1.2 1.5 11,12 11 64 39 14 11 15 2011 10 15 16 187

P0P1P2P3P4 Pharm. D. P3 P3 555 50~600 17.51.1 15.00.8 17 Pyxis 18% residency pharmacist staff pharmacist clinical pharmacist 17 American Society of Health-System Pharmacists, ASHP 18 American College of Clinical Pharmacy 19 20,21 medication use reviewmur 188

new medication services 22 7% 23 National Health Service NHS 2007 National Health ServiceNHS 35% 27% 24 Hospital Pharmacy Residency Accreditation Board 13 13 75% 100,000 1966-1999 2000 4 5 189

2010 25 2 3 2 4 3 6 22 13 11 440 16 640 26 25 27 10 2012 2 16 17 28 130 31 6 18 640 9 4 28 37 28% 13 37 29 2006 30 31 640 190

2008 32 1993 2012 35 170 6.32% 12.50% 9% 13.1% 10% Pharm.D. Advanced Pharmacy Practice Experience, APPE 31,32 post graduate year, PGY 2007 PGY PGY 36,700 3,500 2007 106 631 2010 116 1,210 35 15 7 191

33 34 2006 2011 101 116 11 15%533 5 16%~33% 25 MPharm 35 1960 1883 1980~1990 modulalisationsemesterisation computer-led learning and student-centered learning 1997 2000 problem-stimulated learningproblem solving learning 192

e E-learning 2004 MPharm 36 NHS 2011 modernising pharmacy careers programme 37,38 General Pharmaceutical CouncilGPhC Royal Pharmaceutical Society in Great Britain RPSGBSupplemental Charter, Pharmacy Act 1954European Directive 85432EEC 1985 European Directive 85433EEC 1987criterion indicative syllabus 2010 Royal Pharmaceutical Society RPSGPhC 2010 code of conduct student code of conduct student fitness to practice 39 40 Canadian Council for Accreditation of Pharmacy Programs, CCAPP Association of Faculties of Pharmacy of Canada AFPC BScPharm) or BScPhm 13 1+4 2+4 AFPC 193

post-baccalaureatepharm. D. Pharmacy Examining Board of Canada PEBC NABPBScPhm Pharm.D 13 tenure track 13 1988 2010 60% 89% 1988 2012 2006 6 2000 2012 12 41 Computer-based testing, CBT OSCE 2002 42 OSCE 43 2000 Pharm. D. Pharm. D Pharm. D. ACPE Pharm. D. Pharm. D. 194

National Association of Boards of Pharmacy, NABP Pharmacy Curriculum Outcomes Assessment, PCOA 44 PCOA 220 Pharm. D Pharm. D. 16% 22% 32% PCOA 2009-2011 PCOA 2011 19 2,688 0.9 2011 2,688 0.532 PCOA 2011 40 45 1968 1981 2001 2003 6 96 46 47 2007 2012 195

18.74% 46.35% 28.31% 15%36.57% vs. 21.43% 24.4 vs. 26.5 29.2&31.8 28.4&30.9 2008 4 1 60 1 2008 2012 48 91~98 73.3% Bloom taxonomy 31.9% 2006 98 100 196

320 30.82% 1% 57.40% 26.25%15.0%13.1%10.9% (Structure Activity Reaction, SAR) 17% 31.88% 73.13% 900 1.05:1 587 63% 1 37% 11 15 52 MPharm 39 90 90 120 80 197

20 60 2 70% 70% GPhC 2010 2,176 2,056 120 86.9% North American Pharmacist Licensure Examination NEPLEXComputerized adaptive testing TOEFL GRE 4 15 185 pretesting 35 multiple-choice itemsmultiple-response itemsconstructedresponse itemsordered-response itemshot spot items 49 56% Area 1 Assess Pharmacotherapy to Assure Safe and Effective Therapeutic Outcomes 33% Area 2 Assess Safe and Accurate Preparation and Dispensing of Medications 11% Area 3 Assess, Recommend, and Provide Health Care Information that Promotes Public Health 49 NEPLEX NAPLEX NAPLEX 150 75 NABP NAPLEX MPJEMultistate Pharmacy Jurisprudence ExaminationCalifornia Pharmacist Jurisprudence Exam 50 NAPLEX 198

1 1 1 33 Common test 43 1 2 3 CBTOSCE2 80% 44 OSCE 50 CBT OSCE 60 60 1 2001 2-day case-based multiple-choice test OSCE OSCE 16 199

13 The Pharmacy Examining Board of Canada Qualifying Examination http://www.pebc.ca/index.php/ci_id/3374/ la_id/1.htm OSCE Miller 1990 51 knowsknows howshows howdoes OSCE shows howdoes 2005 52 OSCE high stakes assessment OSCE 1975 Dundee University Harden OSCE OSCE 53 1992 OSCEMCCQE II 54 2003 OSCE 55 2004 USMLE step IIb CS, clinical skill 56 140 50% OSCE 57 OSCE 200

1970 College of Pharmacists of British Columbia, CPBC OSCE 1997 CPBC OSCE OSCE 13 2001 The Pharmacy Examining Board of Canada's Qualifying Examination OSCE OSCE OSCE 58 2006 OSCE OSCE 43 19 OSCE informed consent Roter interaction analysis systemrias OSCE RIAS 50 OSCE 2008 2010 108 88 Pharm.D 81.5% 32 OSCE 11 OSCE 55 OSCE OSCE OSCE 59 201

Advanced Pharmacy Practice Experience, APPEIntroductory Pharmacy Practice Experience, IPPE OSCE 60 OSCE OSCE do traineespharm.d. candidate does OSCE OSCE OSCE summative examination formative examination OSCE PGY OSCE OSCE 3,5,61 202

OSCE 4 2006 OSCE OSCE OSCE 2008 97 OSCE OSCE OSCE 96 40 114 2009 116 OSCE OSCE OSCE OSCE OSCE 2008 97 OSCE 203

2009 5 1 234 5 5 15 114 111 97.4% 103 90.4% 3.970.693.93 0.704.05 0.663.98 0.753.77 0.83 2 5 4 4.33 0.683.80 0.804.11 0.69 p = 0.039 OSCE OSCE 100 Thrombosis warfarin warfarin OSCE warfarin SOAPnote warfarin 204

7 OSCE 99 47 OSCE OSCE warfarin 11 12 0-5 0-5 0-9 Pearson correlation coefficientcochran's Mantel-Haenszel test Kappa 99 68.7% 22.2% 17% 62.6% 30% 29% 66% 35.891.95 55 41.678.28 60 8.351.95 11 5.581.58 5.151.21 0.750.004 0.3 62 25630 92% Kappa 0.27 0.65 Kappa 0.65 OSCE warfarin 100 205

OSCE OSCE OSCE 97% OSCE 63 13% 68.9% OSCE 73.3% OSCE 15.6% OSCE OSCE 100 warfarin 7 3 OSCE 13,64,65 66 60% 66 67 68 2011 Drugs 69 206

Drugs 69 medication errors 70 71 1 1 72 65 64,65 2 2005 52 2 207

outcome-based education 73 experimental education OSCE 13,43 213 270 32 54%60% 59% OSCE 25 62% 44% 28% 487 203 34 36.9% 41.2% 21.2% 10.5% 8.3% 1.0% 75% OSCE 6.3% 51.9% OSCE OSCE OSCE 208

OSCE OSCE OSCE OSCE OSCE OSCE 2006 OSCE OSCE OSCE 14 1 1 1 56 40 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 10 9 209

OSCE SWOT OSCE 1 23 OSCE SWOT OSCE OSCE SWOT OSCE SWOT OSCE SWOT 1 OSCE 2 OSCE 1 OSCE OSCE 2 3 OSCE 1 56 210

40 23 1 OSCE 2 OSCE 1 OSCE 2 OSCE 3 OSCE 12 1 IPPE OSCE 2 OSCE 12 3 37%4 OSCE 5 6 12 3 4 5 OSCE 211

1 OSCE 2 1 OSCE 2 OSCE 3 OSCEs 4 5 OSCEs 1 OSCE 2 OSCE 3 OSCE 1 23 OSCE 1 14 2 1 OSCEMini-CEX DOPS OSCE 2 OSCE 3 OSCE 4 OSCE OSCE 1 OSCE 212

2 OSCE OSCE 3 1 2 3 4 OSCE 1 14 2 1 OSCE2 3 1 OSCE 2 OSCE 1 2 12 213

74 OSCE 22% OSCE OSCE OSCEMini-CEX DOPS OSCEMini-CEX DOPS OSCE OSCE OSCE OSCE OSCE 1 2 OSCE OSCE OSCE 9,75 OSCE OSCE 214

OSCE OSCE OSCE 215

OSCE SWOT Strength Weakness OSCE OSCE OSCE OSCE OSCE OSCE OSCE OSCE OSCE OSCE Opportunity Threat 14 OSCEMini-CEX DOPS OSCEs OSCE OSCE OSCE Mini-CEX DOPS OSCE OSCE OSCEs 216

1.,.. (The Journal of Taiwan Pharmacy). 2011;27 (4):1-13. 2.. - :, ; 2010. 3.,,,.. (The Journal of Taiwan Pharmacy). 2012;25 (3):146-151. 4.,.. (Formosa Journal of Clinical Pharmacy). 2010;18 (1):51-72. 5.,, 媖, et al. OSCE.. 2010;18 (4):1-17. 6... 7.. 2012. 8.... 99 / 01.11-01.24, 2010. 9.,. OSCE : ; 11/23/2011 2011. 10... (Pharmacy Weekly) 2012. 11.. 99 2010. 12... (The Journal of Taiwan Pharmacy)2012;28 (1):1-14. 13. Austin Z, Ensom MH. Education of pharmacists in Canada. American journal of pharmaceutical education. Dec 15 2008;72 (6):128. 14.,,.. 2006. 15... 2011. 16.. 2011. 17. Pedersen CA, Schneider PJ, Scheckelhoff DJ. ASHP national survey of pharmacy practice in hospital settings: prescribing and transcribing--2010. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health- 217

System Pharmacists. Apr 15 2011;68 (8):669-688. 18. American Society of Health-System Pharmacists. Residency Accreditation 2012; http://www.ashp.org/menu/accreditation/residencyaccreditation.aspx 19. American College of Clinical Pharmacy. Board Certification. 2012 http://www.accp. com/careers/certification.aspx 20. Department of Health UK. Pharmacy in the future Implementing the NHS plan A programme for pharmacy in the National Health Service. London, U.K. September 2000. 21. Department of Health UK. Pharmacy workforce in the new NHS Making the best use of staff to deliver the NHS pharmacy programme (A discussion paper) London, U.K. 2002. 22. Department of Health UK. Summary of consulation response to a vision of pharmacy in new NHS. March 2004. 23. Hassell K, Seston EM, Edem M. Pharmacy Workforce Census 2005: Main Findings. London: Royal Pharmaceutical Soceity of Great Britain;2006. 24. Healthcare Commission. Naitonal Survey of NHS Staff 2007. London: Healthcare Commission; 2008. 25.,,. : ; 2009. 26.. 2012. 27.,,, 2000, 8 (12),1-21 28.. 2012/02/16~2012/02/17 2012. 29... 30... 2009. 31. Li-Jiuan Shen, Fe-Lin Lin Wu, Yunn-Fang Ho, Karin CS, Lin C. Evolution of Pharmacy Education in Taiwan. Journal of the Korean Society of Pharmaceutical Regulatory Sciences. 2008;3 ( (1,2)):71-77. 32.. 2010. 33.,. 2011. 218

34.. 35. General Pharmaceutical Council. http://www.pharmacyregulation.org/education/ pharmacist/accredited-mpharm-degrees. Accessed August 7, 2012. 36. Department of Health UK. Summary of consulation response to a vision of pharmacy in new NHS. March 2004. 37. Hassell K. Supply and demand for pharmacy Workforce in Great Britian. Manchester: University of Manchester; 2003. 38. Guile D, Ahamed F. Modernising the pharmacy curriculum. Vol LLAKES Research Paper 26: Centre for Learning and Life Chances in Knowledge Economies and Societies, U.K. 2011. 39. Smith A, Darracott R. Modernising pharmcy careers programme. Review of pharmacist undergraduate education and pre-registration traning and proposals for reform. January 2011. 40. Council GP. Code of conduct for pharmacy students. London September 2010. 41... (The Journal of Taiwan Pharmacy). 2012;28 (1). 42. Tanaka N, Maruyama M, Amagai A, et al. [Development and evaluation of communication skills learning suitable for community pharmacy]. Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan. Jan 2008;128 (1):97-110. 43. Ichikawa A. [Pharmaceutical Common Achievement Test: computer-based testing (CBT)]. Yakugaku zasshi : Journal of the Pharmaceutical Society of Japan. Jun 2007;127 (6):941-945. 44. National Association of Boards of Pharmacy.Pharmacy Curriculum Outcomes Assessment. 2012. 45. National Association of Boards of Pharmacy. 2009-2011 PCOA Administration Highlights 2011. 46.... 1010517, 2012. 47.. ; 2012. http://wwwc.moex.gov.tw/main/ ExamReport/wFrmExamStatistics.aspx?menu_id=158. Accessed August 2, 2012. 48.. 101. 2012; http://wwwc.moex.gov.tw/main/ news/wfrmnews.aspx?kind=3&menu_id=42&news_id=970 219

49. National Association of Boards of Pharmacy. North American Pharmacist Licensure Examination (NAPLEX) & Multistate Pharmacy Jurisprudence Examination (MPJE) Registration Bulletin2012. 50. Kubota Y, Yano Y, Seki S, et al. Assessment of pharmacy students' communication competence using the Roter Interaction Analysis System during objective structured clinical examinations. American journal of pharmaceutical education. Apr 11 2011;75 (3):43. 51. Miller GE. The assessment of clinical skills/competence/performance. Acad Med 1990;65:563-567. 52.,,, et al. 2005.. 2006;10:165-185. 53. Lee YM, Ahn DS. The OSCE: a new challenge to the evaluation system in Korea. Medical teacher. Jun 2006;28 (4):377-379. 54. Reznick R, Smee S, Rothman A, et al. An objective structured clinical examination for the licentiate: report of the pilot project of the Medical Council of Canada. Acad Med. Aug 1992;67 (8):487-494. 55. Onishi H, Yoshida I. Rapid change in Japanese medical education. Medical teacher. Aug 2004;26 (5):403-408. 56. De Champlain A, Swygert K, Swanson DB, Boulet JR. Assessing the underlying structure of the United States Medical Licensing Examination Step 2 test of clinical skills using confirmatory factor analysis. Acad Med. Oct 2006;81 (10 Suppl):S17-20. 57... 2006. 58. Austin Z, O'Byrne C, Pugsley J, Munoz LQ. Development and Validation Processes for an Objective Structured Clinical Examination (OSCE) for Entry-to-Practice Certification in Pharmacy: The Canadian Experience. American journal of pharmaceutical education. 2003;67 (3) Article 76. 59. Sturpe DA. Objective structured clinical examinations in doctor of pharmacy programs in the United States. American journal of pharmaceutical education. Oct 11 2010;74 (8):148. 60. Kimberlin CL. Communicating with patients: skills assessment in US colleges of 220

pharmacy. American journal of pharmaceutical education. Jun 15 2006;70 (3):67. 61.,,,,. OSCE. (Formosa Journal of Clinical Pharmacy). 2010;18 (1):33-50. 62. Austin Z, Gregory PA, Galli M. "I just don't know what I'm supposed to know": evaluating self-assessment skills of international pharmacy graduates in Canada. Research in social & administrative pharmacy : RSAP. Jun 2008;4 (2):115-124. 63. Awaisu A, Abd Rahman NS, Nik Mohamed MH, Bux Rahman Bux SH, Mohamed Nazar NI. Malaysian pharmacy students' assessment of an objective structured clinical examination (OSCE). American journal of pharmaceutical education. Mar 10 2010;74 (2):34. 64. Huang YM, Wang HP, Yang YH, et al. Effects of a national health education program on the medication knowledge of the public in Taiwan. The Annals of pharmacotherapy. Jan 2006;40 (1):102-108. 65. Wen MF, Lin SJ, Yang YH, et al. Effects of a national medication education program in Taiwan to change the public's perceptions of the roles and functions of pharmacists. Patient education and counseling. Mar 2007;65 (3):303-310. 66..... Vol 2 2009:164-173. 67. ASHP long-range vision for the pharmacy work force in hospitals and health systems: ensuring the best use of medicines in hospitals and health systems. American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists. Jun 2007;64 (12):1320-1330. 68. Worley MM. Testing a pharmacist-patient relationship quality model among older persons with diabetes. Research in social & administrative pharmacy : RSAP. Mar 2006;2 (1):1-21. 69. Drugs. : ; 2011. 70.... 2012 6 21 1:50, 2012. 71.... 2012 March 22, 2012. 72. 1 1. ETtoday. 20120322, 2012. 221

73. Brown N, Doshi M. Assessing professional and clinical competence: the way forward. Advances in Psychiatric treatment. Advances in Psychiatric treatment. 2006;12:81-91. 74... (TZU CHI NURSING JOURNAL). 2011;10 (3):19-27. 75.. OSCE. 2011. 222

223

224

225

226

227

228

229

230

231

232

233

234

235

236

237

238

Objective Structured Clinical Examinations (OSCEs) 臨 a performance-based tool comprised of a series of stations through which all examinees rotate on a timed basis. In each station, the examinee is faced with a simulated task or problem the examinee is required to perform specific functions to complete the task or address the problem each examinee in an interactive i station is observed and assessed by a trained examiner using a standardized marking key Austin Z, 2003 34 239

240

241

242

243

244

245

246

247

248

249

250

251

252

253

254

OSCE SWOT- 行 Word file -- 力 66 255

256

257

258

259

260

261

262

OSCE 1 2010 80% OSCE 91~98 73% 32% 2012 170 / 7%~12.5% 99~100 62 90 16% 39% 1 263

OSCE OSCE 16 6 5 4 OSCE OSCE shows how OSCE 1. OSCE 2. 3. OSCE 2010 7.8 15.8 1.9 2.4 1.2 1.5 264

265

266

267

268

269

270

271

272

OSCE 1 OSCE OSCE OSCE OSCE OSCE OSCE 1. OSCE ANS Objective Structure Clinical Examination, OSCE OSCE 2. ANS 1 273

3. 4. OSCE OSCE 5. OSCE 274

肆 照 片 選 輯 275

276

277

278

OSCE 279

280

附 錄 會 議 資 料 281

壹 緣 起 一 前 言 WTOAPEC 94 95 96 97 98 99 e 100 OSCE 101 OSCE 282

二 研 討 會 目 的 Objective Structured Clinical Examination; OSCE Dundee University Dr. Ronald Harden 1975 objectivestructured clinical examination OSCE OSCE 三 研 討 會 進 行 方 式 OSCE OSCE 10 30 40 10 30 40 10 283

四 預 期 成 效 OSCE 284

貳 日 程 表 101 9 21 1 1 議 程 8:309:00 9:00 9:009:30 OSCE 9:3012:20 9:309:40 9:4010:10 10:1010:40 10:4010:50 10:5011:00 11:0011:10 11:1011:20 11:2011:30 11:3011:40 285

11:4012:10 12:1012:20 12:2014:00 OSCE 14:0016:10 14:0014:10 14:1014:50 14:5015:10 15:1015:20 15:2015:30 15:3015:40 15:4016:20 16:2016:30 16:30 286

參 研 討 會 注 意 事 項 一 報 到 服 務 二 研 討 會 各 場 次 時 間 分 配 10 30 40 10 30 40 3 2 30 3 10 三 其 他 注 意 事 項 287

肆 第 一 場 次 主 持 人 報 告 人 簡 歷 11 5 贋 贋 贋 贋 288

289

與 談 人 簡 歷 Journal of Dental SciencesSCIEditor-in-Chief Journal of Endodontics, Editorial Board IADRSEACouncilor & Country Representative SEAADE TFDA TFDA SNQ 290

AAP 291

292

293

CIP OSCE. --. -- 102.01 --. 101 1 ISBN 978-986-03-6040-0 1. 2. 573.44065 102001934 OSCE 11602 1 1 022236-9188 http://www.moex.gov.tw 102 1 9 12 0223567763 250 GPN1010200271 ISBN978-986-03-6040-0