外科实习中讲座与标准化病人互动的比较：一项随机前瞻性交叉研究。

Carter Mary B, Wesley Gina, Larson Gerald M

Medical Education Research Unit, Office of Medical Education, Instructional Building B, Room 308, School of Medicine, University of Louisville, Louisville, KY 40292, USA.

Am J Surg. 2006 Feb;191(2):262-7. doi: 10.1016/j.amjsurg.2005.06.045.

BACKGROUND

Medical schools increasingly are incorporating the standardized patient (SP) interaction as a teaching and testing modality to prepare students for United States Medical Licensing Examination Step 2 Clinical Skills. Although SP interactions provide a safe environment in which to practice clinical skills, little is known about medical students' perceptions of the instructional SP interaction in comparison with the classic didactic lecture. We hypothesized that students would enjoy and value an instructional SP interaction more than a didactic lecture, and that this perception would be enhanced if the lecture immediately preceded the instructional SP interaction.

METHODS

Students on the junior surgery clerkship from January to December 2004 were randomized into 2 groups. Group A (n = 71) received an hour-long didactic lecture about peripheral vascular disease followed by a 20-minute instructional SP interaction in which the SP portrayed a patient with lower-extremity claudication. Group B (n = 72) received the SP interaction first, followed by the lecture. All students received an identical quiz about peripheral vascular disease after the second educational encounter, whether the SP interaction or the lecture. Student perceptions were surveyed by written questionnaire before and after the session by using a 5-point Likert scale, with 5 being the most favorable rating. Data (perceptions, performances on the quiz and the SP interaction, clerkship grades) were compared using the Student t test or the Mann-Whitney rank sums test.

RESULTS

Although all students on average enjoyed and valued the lecture more than the SP interaction (P <.001), group A students enjoyed the SP interaction more than group B (3.3 +/- .9 vs. 2.8 +/- 1.0, P = .008), and they perceived the SP interaction as having more value to their overall education (3.3 +/- 1.0 vs. 2.8 +/- 1.0, P = .004). Group A students performed statistically better on the physical examination (66% +/- 19% vs. 40% +/- 16%, P <.001) and communication portions (90% +/- 11% vs. 79% +/- 12%, P <.001) of the SP checklist than group B, but not on the history portion. Student confidence in their own history and physical examination skills increased similarly for both groups.

CONCLUSIONS

The classic lecture format not only is enjoyed and valued as a learning tool more by our surgical clerkship students than the instructional SP interaction, but having a lecture just before an SP interaction increased perceived enjoyment and value of the SP interaction and enhanced performance on the SP checklist. These data suggest that educators can improve student perceptions and attitudes surrounding the instructional SP interaction by using strategically timed lectures.

背景

医学院校越来越多地将标准化病人（SP）互动作为一种教学和测试方式，以使学生为美国医师执照考试第二步临床技能做好准备。尽管SP互动提供了一个练习临床技能的安全环境，但与传统的理论讲座相比，医学生对指导性SP互动的看法却知之甚少。我们假设，与理论讲座相比，学生们会更喜欢并更重视指导性SP互动，而且如果在指导性SP互动之前紧接着进行讲座，这种看法会得到加强。

方法

将2004年1月至12月参加外科初级实习的学生随机分为两组。A组（n = 71）先接受了一个小时关于周围血管疾病的理论讲座，随后是一个20分钟的指导性SP互动，其中标准化病人扮演一名下肢间歇性跛行的患者。B组（n = 72）先进行SP互动，然后是讲座。在第二次教育接触（无论是SP互动还是讲座）之后，所有学生都接受了一份关于周围血管疾病的相同测验。通过书面问卷在课程前后使用5点李克特量表对学生的看法进行调查，5分为最有利的评分。使用学生t检验或曼-惠特尼秩和检验对数据（看法、测验和SP互动中的表现、实习成绩）进行比较。

结果

尽管所有学生平均而言更喜欢并更重视讲座而非SP互动（P <.001），但A组学生比B组学生更喜欢SP互动（3.3±0.9对2.8±1.0，P = .008），并且他们认为SP互动对他们的整体教育更有价值（3.3±1.0对2.8±1.0，P = .004）。在SP检查表的体格检查部分（66%±19%对40%±16%，P <.001）和沟通部分（90%±11%对79%±12%，P <.001），A组学生的表现从统计学上看比B组更好，但在病史部分则不然。两组学生对自己病史和体格检查技能的信心提升程度相似。