将儿童用作标准化患者以评估儿科临床能力。
Using children as standardised patients for assessing clinical competence in paediatrics.
作者信息
Tsai T-C
机构信息
Department of Pediatrics, Mackay Memorial Hospital, Mackay Medicine, Nursing and Management College, Taiwan, ROC.
出版信息
Arch Dis Child. 2004 Dec;89(12):1117-20. doi: 10.1136/adc.2003.037325.
BACKGROUND
Standardised patients (SPs) have been widely used to assess physicians' clinical competence. However, in paediatrics, the use of children in such a way has long been questioned with regard to ethics and the examination quality (in terms of validity, reliability, and feasibility).
AIMS
To summarise the current state of the use of child SPs, and to highlight the difficulties inherent in the use of children for this purpose.
METHODS
Nineteen articles dealing with the use of child SPs for clinical assessment were reviewed.
RESULTS
Child SPs, ranging in age from infancy to adolescence, were present in varied proportions of paediatric objective structured clinical examination stations (12-27%). In most of these reports, there were several children with cases who could substitute for one another. Child SPs successfully portrayed various roles, although only older children had to learn a scenario. In general, clinical examinations using child SPs were found to be valid and generated reliable scores. Child SPs also provided effective feedback. The experience tended to be considered negative for younger children but was quite positive for a number of older children. The use of young SPs should be avoided for ethical reasons, and the use of child SPs should be limited to assessments that cannot be satisfactorily measured by other methods.
CONCLUSION
Through meticulous attention to detail and careful planning, a clinical examination using children as SPs can be practical, valid, and reliable.
背景
标准化病人（SPs）已被广泛用于评估医生的临床能力。然而，在儿科领域，以这种方式使用儿童在伦理和检查质量（在有效性、可靠性和可行性方面）方面长期受到质疑。
目的
总结儿童标准化病人的使用现状，并强调为此目的使用儿童所固有的困难。
方法
对19篇关于使用儿童标准化病人进行临床评估的文章进行了综述。
结果
年龄从婴儿期到青春期的儿童标准化病人在儿科客观结构化临床考试站中所占比例各不相同（12%-27%）。在大多数这些报告中，有几个患有病例的儿童可以相互替代。儿童标准化病人成功地扮演了各种角色，不过只有年龄较大的儿童需要学习一个场景。总体而言，使用儿童标准化病人进行的临床检查被认为是有效的，并且产生了可靠的分数。儿童标准化病人也提供了有效的反馈。这种经历对年幼儿童来说往往被认为是负面的，但对一些年龄较大的儿童来说却是相当积极的。出于伦理原因，应避免使用年幼的标准化病人，儿童标准化病人的使用应限于其他方法无法令人满意地测量的评估。
结论
通过对细节的精心关注和仔细规划，以儿童作为标准化病人进行的临床检查可以是实用、有效和可靠的。
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