| PrefaceClinical competence is an essential practical ability in medical students' clinical practicing works, and it is a crucial component in medical examinations to evaluate the medical students' clinical competence. To evaluate clinical competence objectively and efficiently is a problem long been researching among the clinical educational fields in both China and abroad.The evaluation of clinical competence can be summarized to clinical theoretical exam and clinical practical exam. MCQs has been used in medical exams more and more widely, but it is limited to be used in evaluating cognitive skills. To comprehensively evaluate the abilities in cognitive, affective and psychomotor domains, clinical practical exam is needed. Traditional clinical practical exam is mainly bed - side cases in ward, the content of exam is at will, and the scoring method is objective. In China Medical University, the clinical competence of the 5th year medical students to be graduated is evaluated by Objective Structured Clinical Examination (OSCE).Computer - based Case Simulations ( CCS) exam is a test method newly added in the year 2002's OSCE. CCS has been researched and developed for decades abroad, the United States Medical Licensing Examination has already used CCS in Step 3. The research of CCS in our country has not been reported. We used the advanced foreign conceptions for reference, developed a pilot CCS examination system in a-bout 1 year, and used it in OSCE of the final examination in 2002,and studied the testing data.The Development of Computer - based Case Simulations SystemCCS presents an interactive, dynamic simulation of a patient -care situation. Each case begins with an opening scenario describing the patient's location and presentation. Using free - text entry, the examinee then orders tests, treatments while advancing the case through simulated time. The simulated patient's condition changes based both on the actions taken by the examinee and the underlying problem until the case end. The simulations are scored using a computer - automated algorithm that is designed to approximate the score that would have been produced if the examinee's performance had been reviewed and rated by a group of expert clinicians.Subjects and MethodsThe candidates include all the 258 students taken the final post -practicing comprehensive examination of China Medical University. The test time range from April 9, 2002 to April 19, 2002. We studied the reliability and validity of the OSCE after introducing CCS into the exam, and the difficulty and discrimination of CCS using educational measurement method. We carried out a survey to study the evaluation to CCS by the examinees. Also we studied the testing data using statistical method using Pearson correlation and Factorial analysis. All the analysis are carried out using the SPSS 11.0 software.ResultsThe reliability of the OSCE is 0. 87, and the criterion - related validity is 0.28 (the criterion is the score of the 4th year comprehensive theory examination). The reliability of CCS in this Examination is 0. 27, the validity is 0.15, the average difficulty is 0.52, and the average discrimination is 0.42. CCS and other test forms have a relatively weak, but statistically significant correlation.In the survey, 94.2% of the examinees approve the CCS, 5. 8% neutral, nobody oppose. 73.3% of the examinees consider the interface to be friendly, 25. 4% believe the interface to be common, 1.3% consider the interface to be unfriendly. 95. 8% of the examinees consent with using CCS in the teaching process and systematically intensify the training of clinical reasoning, 4.2% neutral, nobody oppose. 41. 1 % of the examinees believe the training of their clinical reasoning to be important, 51. 1% consider it not that important, 7.1% neglect this aspect. As to the difficulties in answering CCS, 45.4% of the examinees selected the unskillful maneuver of computer as a reason, 43. 3% selected nervousness during the test, 36. 3% consider their clinical knowledge limited,... |
PDF Full Text Request