Jacobs J C G, Denessen E, Postma C T
Department of Medical Education, University Medical Centre Nijmegen, the Netherlands.
Neth J Med. 2004 Nov;62(10):397-403.
Medical competence is a central concept in medical education. Educational efforts in medical training are directed at the achievement of a maximal medical competence. The concept of the structure of medical competence (multidimensional or one-dimensional with strongly interrelated competences) therefore affects the educational developments and assessment procedures.
To examine the applicability of a one or more dimensional character of medical competence in student assessments, by analysing the results of 356 students in the history taking station of an objective structured clinical examination (OSCE), in relation to other assessment procedures.
The performances of 356 students in a history taking station of an OSCE were analysed. Analyses of the checklist scores were aimed at the dimensionality of history taking skills. External criteria were used to test the validity of the scores on the checklist.
The analyses of the scores on the history taking checklist indicated at least five dimensions of history taking skills: the frequency of patient-centred skills, the quality of performance of patient-centred skills, complaint-oriented skills, general social skills, and the provision of procedural information.
Medical competence, as a subject of assessment, can be seen as a multifaceted construct. This study shows that history taking alone might be composed of five different dimensions, suggesting that medical competence in respect of assessment might be viewed as a multifaceted construct which in that sense has implications for the assessment of medical competence.
医学能力是医学教育中的核心概念。医学培训中的教育努力旨在实现最大程度的医学能力。因此，医学能力结构的概念（多维度或具有紧密相关能力的单维度）会影响教育发展和评估程序。
通过分析356名学生在客观结构化临床考试（OSCE）病史采集站的成绩，并与其他评估程序相关联，来检验医学能力的单维度或多维度特征在学生评估中的适用性。
分析了356名学生在OSCE病史采集站的表现。对检查表分数的分析旨在确定病史采集技能的维度。使用外部标准来检验检查表上分数的有效性。
对病史采集检查表分数的分析表明，病史采集技能至少有五个维度：以患者为中心技能的频率、以患者为中心技能的表现质量、主诉导向技能、一般社交技能以及提供程序信息。
作为评估对象的医学能力可被视为一个多方面的结构。本研究表明，仅病史采集可能由五个不同维度组成，这表明在评估方面，医学能力可能被视为一个多方面的结构，从这个意义上讲，这对医学能力的评估有影响。
