專科護理師甄審口試劇本訓練模組建構之成效

Abstract

專科護理師（簡稱專師）（Nurse practitioner, NP）是本國唯一具有國家證照之進階護理師，與醫師共同提供病人醫療及執行護理照護業務，須通過筆試及口試才能領取執業執照。專師執行病人照顧須展現的臨床推理能力較無法以紙筆測驗評量，故甄審口試採用客觀結構式臨床考試（Objective structured clinical examination,OSCE）以彌補筆試無法評值出的臨床實作能力。OSCE的口試劇本稱之「活考題」，需由標準化病人（Standardized patient, SP）扮演情境角色，真人演出若缺乏一致性可能影響考生的表現，過去每年約有2-3件考生反應SP演出問題的申訴案件。標準化病人訓練師（Standardized patienttrainer,SPT）是訓練SP表演教案的重要角色，過去大多由資深NP或曾擔任SP的資深救護技術員（Emergency medical technician, EMT）擔任口試劇本訓練的SPT，依舉辦單位設計的流程訓練SP，未有前置之SPT訓練課程。有鑑於SP演出涉及 考生的口試成績表現，演出品質的把關相形重要，本文目的為探討應用劇本訓練模組課程進行SPT訓練後，SPT對課程的學習滿意度及考生申覆案件之改善結果。採用「標準化病人師資訓練課程學習滿意度問卷」，包括「課程教材」、「課室訓練課程」，及「劇本實作訓練」三個構面，以李克氏5分法（1分為「非常不滿意」，5分為「非常滿意」） 進行學習成效評值；申覆SP演出件數由舉辦單位提供。參與訓練的SPT共計21位，資深NP 6位，資深EMT 15位。學習滿意度分析發現口試演出結束後總平均分數高於劇本訓練完成後，其中「劇本實作訓練」達統計顯著差異（p< .05），顯示SPT對訓練模組課程的肯定外，109年甄審口試後首次無考生提出SP演出申覆案件。研究發現訓練模組課程能培育出勝任專師甄審口試劇本訓練的SPT。  Nurse practitioners (NP) are the only advanced nurse practitioners with a national license in Taiwan.NPs work with physicians to provide medical treatment and perform nursing care services. NPs must pass written and oral exams to obtain practicing license. The required clinical reasoning ability is difficult to evaluate by using written tests. Therefore, the objective structured clinical examination (OSCE) is chosen to examine practical and clinical ability of future NPs. OSCE scripts are called “living exam questions” and require standardized patients (SP) to play the role in the determined context. Lack of consistency in SPs’ live-action affects the performance of candidates. In the past, candidates’ appeal due to SP performance was about 2 to 3 times per year. Standardized Patient Trainer (SPT) plays a vital role in SP training. In the past, senior NPs or senior emergency medical technicians (EMT), served as the SPT in oral script training, depending on the organizer. There is no pre-SPT training course in the designed process. The quality of SPs’ performance is important because it affects the candidates’performance in the oral exam. Thus, the purpose of this study is to investigate the improvements of SPT’s learning satisfaction and candidates’ appeal rate after SPTs training program adopting the script training module course. A total of 21 SPTs participated in the training program, including 6 senior NPs and 15 senior EMTs. The study adopted the “Learning satisfaction questionnaire of standardized patient trainer training course, (LSQSPTTC), “including three domains of “curriculum materials,”“lesson training,” and “script practice training.” Also, use the Likert 5-point scale (1-very dissatisfied and 5-very satisfied) to evaluate the learning effectiveness. Furthermore, the number of incidents of candidates’ appeal due to SP performance was provided by the examination organizer. The learning satisfaction after the oral exams is higher than the completion of the script training. The domain of “script practice training” had a statistically significant difference (p < 0.05), indicating that SPTs satisfied with the training module courses. Furthermore, there is no appeal incident due to SP performance in the 109th Republic of China for the first time. The results support that the training module courses can effectively prepare SPTs to be competent for SP scripts training dedicated to NP screening exams.