給每組 facilitator 的逐步帶領指引，分兩部分：Part 1 以「CCC Checklist」帶出小組共識；Part 2 帶領「CCC 會議角色扮演」。內容對齊 ACGME 對臨床能力委員會（Clinical Competency Committee）之精神。A step-by-step guide for each group's facilitator, in two parts: Part 1 builds group consensus using the CCC Checklist; Part 2 runs a CCC-meeting role-play. Aligned with ACGME's intent for the Clinical Competency Committee.
3 分鐘速覽：ACGME 眼中的 CCC3-minute primer: the CCC per ACGME
組成：由訓練計畫主任指派，至少 3 位計畫教師（含至少一位核心教師），可納入其他職類與外部成員。Composition: appointed by the program director; at least three program faculty (incl. ≥1 core faculty), and may include other professions and external members.
任務：定期（至少每半年）審視所有學員的多元評核資料，判定其在里程碑（Milestones）的發展，並向計畫主任建議晉級、補強或輔導。Charge: review all residents' multi-source assessment data at least semi-annually, judge progress on the Milestones, and advise the program director on promotion, remediation or support.
精神：以群體判讀取代單一評分者，降低個人偏誤；以具體事證為本；最終形成對標準的共享心智模型，並做出信賴授權與量身打造的學習計畫。Spirit: replace a single rater with group judgement to reduce bias; ground decisions in objective evidence; build a shared mental model of the standard, then make entrustment decisions and a tailored learning plan.
Part 1 · 以 CCC Checklist 帶出小組共識Part 1 · Building consensus with the CCC Checklist
目標：看完情境影片後，帶領小組逐項討論出對 12 個 Checklist 題目的「共識答案」，過程中把每題連回 CCC 委員的任務與角色；最後推派一位報告人。建議 30 分鐘。Goal: after the scenario video, lead the group to a consensus answer on all 12 Checklist items, tying each to a CCC member's task and role; then nominate one reporter. Suggested 30 minutes.
時間Time
步驟Step
引導者要做的事Facilitator does
0–2′
影片回顧Recap
用一兩句點出影片場景（如：一般醫學科 PGY 住院醫師 CCC 會議），提醒大家戴上「評核者」視角。In a sentence, name the scene (e.g., a PGY resident CCC meeting) and ask everyone to put on an "assessor" lens.
2–7′
個人作答Individual
每人獨立就 12 題評「沒有／部分／完全做到」，先不討論。Each member rates all 12 items (not/partly/fully met) independently, no discussion yet.
7–25′
逐項共識Item consensus
逐題快速舉手看分布 → 請意見不同者各以影片事證說明 → 收斂共識（每題約 1–1.5 分）。用下方各題的「引導提問」。Per item: quick show of hands → ask those who differ to cite evidence from the video → converge (≈1–1.5 min/item). Use the per-item prompts below.
25–28′
記錄＋整體成效Record
把共識答案寫上海報；另以 1–5 分評「此決議對學員專業發展／對機構教學規劃」的幫助。Write consensus on the flip-chart; rate 1–5 how the decision helps the learner's development and the institution's planning.
28–30′
推派報告人Reporter
推派一位報告人，準備分享：①討論過程的重要學習 ②小組共識答案。Nominate a reporter to share: ①key learning from the discussion ②the group's consensus.
報告人分享內容（提醒報告人）What the reporter presents
① 討論過程的重要學習：哪幾題分歧最大？是什麼影片事證讓大家改變看法？② 小組共識答案：12 題的共識評級與最關鍵的 2–3 點理由。① Key learning: which items split the group most, and what evidence changed minds? ② Consensus: the agreed rating for the 12 items and the 2–3 most important reasons.
由接受過 CCC 訓練認證之教師擔任主席A CCC-certified teacher chairs the committee
對應角色Role主席（Chair）Chair任務：主持流程、定調、確保結構化討論。ACGME：主席由計畫主任指派、受過訓練。Task: lead the process, set the tone, ensure structured discussion. ACGME: chair is appointed and trained.
引導提問Prompts
影片中誰主持？是否具 CCC 訓練／認證的樣子？Who chairs? Do they appear CCC-trained/certified?
主席如何開場與定調？How did the chair open and set the tone?
部分Part資深但未具 CCC 認證之教師擔任。A senior but non-certified teacher chairs.
沒有No未設主席，或由科部主管逕任。No chair, or a department head simply takes over.
2
開會前已「備妥」及「審視」受評者之學習歷程檔案The learner's portfolio is prepared & reviewed before the meeting
對應角色Role全體委員的會前準備All members' pre-work任務：會前完成 portfolio 整備並留時間審視。ACGME：委員須事先審閱資料。Task: portfolio ready and read in advance. ACGME: members review data beforehand.
引導提問Prompts
學習歷程是否齊備？Is the portfolio complete?
委員看起來是否會前已讀過？Did members appear to have read it beforehand?
完全Full資料完整充足，委員會前有充足時間審視。Complete data; ample time to review beforehand.
部分Part資料完整，但會前審視時間不足。Complete data, but too little time to review.
沒有No資料準備不足，難以評核。Data insufficient for assessment.
3
開會前已「彙整」及「審視」受評者之多元評核資料Multi-source assessment data is compiled & reviewed beforehand
對應角色Role資料彙整者／委員Data integrator / members任務：整合 ≥3 種評核工具與質性回饋。ACGME：以多元評核對照里程碑。Task: integrate ≥3 tools plus qualitative feedback. ACGME: map multi-source data to Milestones.
完全Full≥3 種工具＋質性回饋，整理分析後供會前審視。≥3 tools + qualitative feedback, analysed and reviewed in advance.
部分Part資料足夠但未整理分析，或會前審視不足。Enough data but not analysed, or reviewed too late.
沒有No工具 <3 種或無質性回饋。<3 tools, or no qualitative feedback.
4
主席有依循「由幼至長」的發言原則The chair follows a junior-to-senior speaking order
對應角色Role主席Chair任務：控制發言次序、降低資深定錨偏誤。ACGME：結構化流程以減少偏誤。Task: control turn-taking to reduce senior-anchoring bias. ACGME: structured process to limit bias.
引導提問Prompts
資淺者是否先發言？Did junior members speak first?
主席是否主動點較少發言者？Did the chair invite quieter members?
完全Full依資淺到資深之次序表達。Speaks in junior-to-senior order.
部分Part有鼓勵較少發言之委員。Encourages quieter members.
沒有No主席未主導發言次序。Chair does not order the turns.
5
主席能善用外部委員與團隊中其他職類成員進行回饋Good use of external & multi-professional members for feedback
對應角色Role外部委員／其他職類成員External & allied-health members任務：提供跨領域、跳脫本科的觀點。ACGME：可納入非醫師與外部成員。Task: bring cross-disciplinary, outside-the-specialty views. ACGME: may include non-physician/external members.
引導提問Prompts
有無外部或跨職類委員？Any external or allied-health members?
他們的觀點是否被真正納入？Were their views truly incorporated?
完全Full外部／跨職類成員充分融入並提出啟發性觀點。They engage fully and offer insightful outside views.
部分Part有邀請但未真正融入或缺啟發性。Invited but not really engaged.
沒有No未邀請外部／跨職類成員。No external/allied members invited.
6
討論的過程展現意見的「多樣性」The discussion shows genuine diversity of opinion
對應角色Role全體委員All members任務：以具體臨床觀察與實例呈現多元視角。ACGME：多觀點交叉檢核以提高效度。Task: surface multiple viewpoints with concrete examples. ACGME: triangulate perspectives for validity.
引導提問Prompts
意見是否多元、還是一面倒？Diverse views, or all one-sided?
是否有具體臨床實例支撐？Backed by specific clinical examples?
完全Full以具體觀察展現多元視角與反饋。Multiple viewpoints with concrete observations.
部分Part有討論但意見過於一致、欠缺實例。Discussion happens but views too uniform, few examples.
沒有No過程與內容皆簡略。Both process and content are cursory.
7
決策的過程不受限於「階級」與「和諧」之框架Decisions are not constrained by hierarchy or harmony
對應角色Role主席＋全體Chair + all任務：對事不對人、不因人廢言。ACGME：以證據而非權威主導決策。Task: judge the issue, not the person. ACGME: evidence, not authority, drives decisions.
引導提問Prompts
是否有人因輩分而噤聲？Did anyone stay silent due to rank?
異見是否被尊重與處理？Were dissenting views respected?
完全Full不受階級與和諧框架，不因人廢言。Free of hierarchy/harmony pressure.
沒有No話語分量仍依輩分而定。Weight of voice still follows seniority.
8
決策聚焦於臨床勝任能力的認定與工作之信賴授權Decisions focus on competence and entrustment
對應角色Role全體委員（決策）All members (deciding)任務：明確做出能力認定與信賴授權等級。ACGME：里程碑判定與授權決策。Task: make an explicit competence & entrustment-level decision. ACGME: Milestone judgement & entrustment.
引導提問Prompts
是否真的做出授權等級的決定？Was an entrustment level actually decided?
或只是泛談表現、未收斂？Or just vague talk without converging?
完全Full依勝任能力對工作信賴授權做出決策。Entrustment decided from competence.
部分Part有討論能力但未對授權做決策。Competence discussed but no entrustment decision.
沒有No未聚焦於勝任能力或授權。No focus on competence/entrustment.
9
決策完全依據具體之「客觀事證」Decisions rest fully on concrete objective evidence
對應角色Role全體委員All members任務：以證據為本，而非印象或傳聞。ACGME：可佐證、可追溯的判斷。Task: evidence over impression. ACGME: defensible, traceable judgements.
引導提問Prompts
每個結論是否有具體事證？Is each conclusion evidence-backed?
有無「我覺得」式的印象判斷？Any "I feel that…" impressions?
完全Full完全採納具體客觀事證。Fully grounded in objective evidence.
部分Part部分採納客觀事證。Partly evidence-based.
沒有No未採納具體事證。No objective evidence used.
10
針對學員提出「量身打造」的具體學習或輔導計畫Proposes a tailored learning / coaching plan for the learner
對應角色Role委員會＋導師／教師（執行）Committee + mentor/teacher (delivery)任務：產出個別化、可行的學習計畫（ILP）。ACGME：建議晉級／補強並回饋給學員。Task: produce an individualized, actionable plan (ILP). ACGME: advise promotion/remediation and feed back.
引導提問Prompts
計畫是否具體、可行、個別化？Is the plan concrete, doable, individualized?
有無負責人與時程？An owner and a timeline?
完全Full提出量身打造的具體學習／輔導計畫。A tailored, concrete plan is proposed.
部分Part有計畫但不夠具體或非個別化。A plan exists but is vague/generic.
沒有No未提供學習／輔導計畫。No plan offered.
11
針對教師或課程提出具體的建議或調整Offers concrete suggestions for teachers or the curriculum
對應角色Role委員會（回饋計畫端）Committee (program feedback)任務：把個案發現回饋到課程／師資（閉環）。ACGME：CCC 連結計畫評估與改善。Task: feed case findings back to curriculum/faculty (closing the loop). ACGME: CCC links to program evaluation.
引導提問Prompts
這個案是否點出課程／教學的可改之處？Does this case reveal a curriculum/teaching gap?
有無轉化為具體建議？Turned into a concrete suggestion?
完全Full對教師或課程提出具體建議或調整。Concrete suggestion for teacher/curriculum.
有達到「共享心智模型」之師資培育目的Achieves the shared-mental-model faculty-development goal
對應角色Role全體＋主席All + chair任務：透過討論讓委員對「標準」趨於一致。ACGME：CCC 同時是師資培育與校準的場域。Task: align members on the standard through discussion. ACGME: the CCC is also a faculty-development & calibration arena.
引導提問Prompts
委員對「什麼是足夠／不足」是否更趨一致？Did members converge on "enough vs. not yet"?
過程是否讓彼此校準了標準？Did the process calibrate their standards?
完全Full達到共享心智模型之培育目的。A shared mental model is achieved.
沒有No未達共享心智模型之目的。No shared mental model reached.
Part 2 · 帶領 CCC 會議角色扮演Part 2 · Running the CCC-meeting role-play
目標：以一份學員學習歷程教案，讓小組真正「跑」一場 CCC 會議——由教師與導師說明表現、委員以資料與提問獲取能力證據、共同認定勝任程度，最後做出信賴授權與學習建議。建議 45 分鐘。Goal: with one learner portfolio case, let the group actually "run" a CCC meeting — teacher & mentor describe performance, members gather competence evidence via data and questioning, jointly judge competence, then decide entrustment and a learning plan. Suggested 45 minutes.
① 角色分配（請志願者）① Assign roles (ask for volunteers)
🩺
學員的臨床教師Learner's clinical teacher
1
在會議中說明學員日常臨床工作表現（具體事例、工作場域觀察）。Describe the learner's day-to-day clinical performance (specific examples, workplace observations).
說明學員的學習軌跡、態度與成長，及先前學習計畫之執行。Describe the learner's trajectory, attitude & growth, and progress on any prior plan.
代表學員觀點，提醒個別處境。Represent the learner's perspective and circumstances.
⚖️
委員會委員Committee members
≥3 · 單數≥3 · odd
透過文件資料與向教師／導師提問取得能力證據。Gather competence evidence from documents and by questioning the teacher/mentor.
共同討論並認定此階段的勝任能力；其中一位任主席。Jointly discuss and judge competence; one acts as chair.
人數須為單數（至少 3 人，如 3／5／7 人），以利表決達成共識，避免正反兩方同票而無法收斂。Use an odd number (at least 3, e.g., 3/5/7) so a vote can reach consensus and avoid a pro-con tie.
👁
觀察者Observer
1–2
不介入，以 CCC Checklist 記錄會議是否遵循 12 項原則。Do not intervene; use the CCC Checklist to record whether the meeting follows the 12 principles.
結束後提供回饋。Give feedback at the end.
② 會議流程與時間（引導者主控）② Meeting flow & timing (facilitator-led)
時間Time
環節Segment
引導重點Facilitation focus
0–5′
分派角色＋閱讀教案Roles + reading
發下學員歷程檔案，各角色2–3 分鐘閱讀，戴上自己的角色視角。Hand out the portfolio; each role reads for 2–3 min in character.
5–8′
主席開場Chair opens
主席說明本次評核目的、流程與「由幼至長」發言原則。Chair states the purpose, flow and junior-first speaking rule.
8–18′
教師／導師說明表現Teacher/mentor brief
臨床教師與導師以具體事證陳述學員表現；提醒「對齊能力構面，不流於印象」。Teacher & mentor describe performance with concrete evidence; keep it competency-anchored, not impressionistic.
18–30′
委員提問與審視資料Members question & review
委員依文件提問、交叉檢核，展現多樣性；引導者確保資淺者先說、外部觀點被納入。Members question from the data, triangulate, show diversity; ensure junior-first and external input.
30–38′
認定能力＋信賴授權決議Judge & entrust
收斂出此階段勝任能力，並對相關工作做出信賴授權等級（見下方階梯）。Converge on competence and decide an entrustment level for the relevant task (ladder below).
38–43′
量身學習建議Tailored plan
共擬具體、可行、個別化的學習／輔導建議，指定負責人與時程。Co-draft a concrete, actionable, individualized plan with owner & timeline.
43–45′
觀察者回饋Observer feedback
觀察者以 Checklist 回饋：哪些原則做到、哪些可加強。Observers feed back via the Checklist: what was met, what to strengthen.
會議產出（請主席於結束前確認）Meeting outputs (chair confirms before closing)
能力認定：此階段在相關能力構面／里程碑的判定。Competence judgement: level on the relevant domains / Milestones.
信賴授權：對特定工作的授權等級與督導條件。Entrustment: the level and supervision conditions for a specific task.
學習建議：量身打造的下一步、負責人與追蹤時點。Learning plan: tailored next steps, owner and follow-up date.
信賴授權等級（決議時參考）Entrustment levels (reference for the decision)
L1
在場觀察Observe only
僅能在旁觀察，尚不可執行。May observe; not yet perform.
L2
直接督導Direct supervision
在場直接督導下執行。Performs with supervisor present.
L3
間接督導Indirect supervision
督導可即時到位下執行。Performs with supervisor reachable.
L4
獨立執行Independent
可獨立執行、事後回報。Performs independently; reports after.
L5
督導他人Supervise others
可指導更資淺者執行。Can supervise juniors.
現場常見狀況與處理Common situations & how to handle them
資深者主導、其他人沉默A senior dominates; others stay quiet
回到「由幼至長」：先點名資淺成員，請每人至少給一個事證；資深者最後總結。Return to junior-first: call on junior members first, ask each for one piece of evidence; the senior summarizes last.
只談印象、缺乏事證Impressions without evidence
追問「你是從哪份資料／哪次觀察得到的？」把對話拉回客觀事證（第 9 題）。Probe "from which document/observation did you see that?" — pull it back to objective evidence (item 9).
為和諧而草草同意Premature agreement for harmony
刻意請一位「唱反調」：有沒有相反的證據？讓多樣性浮現（第 6、7 題）。Deliberately assign a devil's advocate: any contrary evidence? Let diversity surface (items 6, 7).
討論發散、時間超時Discussion sprawls; over time
用「我們先把這題收斂到一個共識評級」回到結構；必要時記下分歧點留待全班討論。Use "let's converge this item to one rating" to restructure; park disagreements for the plenary.
一句話收尾One-line close
CCC 的價值不在「打幾分」，而在用群體判讀與具體事證，為每位學員做出可信賴的能力決定與下一步——這也正是 12 題 Checklist 想守護的事。The value of a CCC is not the score, but using group judgement and concrete evidence to make a trustworthy decision and next step for each learner — which is exactly what the 12-item Checklist protects.