Stevens Amy, Hernandez Jonathan, Johnsen Kyle, Dickerson Robert, Raij Andrew, Harrison Cyrus, DiPietro Meredith, Allen Bryan, Ferdig Richard, Foti Sebastian, Jackson Jonathan, Shin Min, Cendan Juan, Watson Robert, Duerson Margaret, Lok Benjamin, Cohen Marc, Wagner Peggy, Lind D Scott
College of Medicine, University of Florida, Gainesville, FL, USA.
Am J Surg. 2006 Jun;191(6):806-11. doi: 10.1016/j.amjsurg.2006.03.002.
At most institutions, medical students learn communication skills through the use of standardized patients (SPs), but SPs are time and resource expensive. Virtual patients (VPs) may offer several advantages over SPs, but little data exist regarding the use of VPs in teaching communication skills. Therefore, we report our initial efforts to create an interactive virtual clinical scenario of a patient with acute abdominal pain to teach medical students history-taking and communication skills.
In the virtual scenario, a life-sized VP is projected on the wall of an examination room. Before the virtual encounter, the student reviews patient information on a handheld tablet personal computer, and they are directed to take a history and develop a differential diagnosis. The virtual system includes 2 networked personal computers (PCs), 1 data projector, 2 USB2 Web cameras to track the user's head and hand movement, a tablet PC, and a microphone. The VP is programmed with specific answers and gestures in response to questions asked by students. The VP responses to student questions were developed by reviewing videotapes of students' performances with real SPs. After obtaining informed consent, 20 students underwent voice recognition training followed by a videotaped VP encounter. Immediately after the virtual scenario, students completed a technology and SP questionnaire (Maastricht Simulated Patient Assessment).
All participants had prior experience with real SPs. Initially, the VP correctly recognized approximately 60% of the student's questions, and improving the script depth and variability of the VP responses enhanced most incorrect voice recognition. Student comments were favorable particularly related to feedback provided by the virtual instructor. The overall student rating of the virtual experience was 6.47 +/- 1.63 (1 = lowest, 10 = highest) for version 1.0 and 7.22 +/- 1.76 for version 2.0 (4 months later) reflecting enhanced voice recognition and other technological improvements. These overall ratings compare favorably to a 7.47 +/- 1.16 student rating for real SPs.
Despite current technological limitations, virtual clinical scenarios could provide students a controllable, secure, and safe learning environment with the opportunity for extensive repetitive practice with feedback without consequence to a real or SP.
在大多数院校，医学生通过标准化病人（SP）来学习沟通技巧，但标准化病人耗费时间和资源。虚拟病人（VP）相比标准化病人可能具有若干优势，但关于在沟通技巧教学中使用虚拟病人的数据却很少。因此，我们报告了我们最初创建一名急性腹痛患者交互式虚拟临床场景以教授医学生病史采集和沟通技巧的工作。
在虚拟场景中，一个真人大小的虚拟病人投影在检查室的墙上。在虚拟问诊之前，学生在手持平板电脑上查看患者信息，并被要求采集病史并做出鉴别诊断。虚拟系统包括两台联网的个人计算机（PC）、一台数据投影仪、两个用于跟踪用户头部和手部动作的USB2网络摄像头、一台平板电脑和一个麦克风。虚拟病人被编程为根据学生提出的问题给出特定的回答和手势。虚拟病人对学生问题的回答是通过查看学生与真实标准化病人表现的录像带而制定的。在获得知情同意后，20名学生接受了语音识别训练，随后进行了一次录像的虚拟病人问诊。在虚拟场景结束后，学生们立即完成了一份技术和标准化病人问卷（马斯特里赫特模拟病人评估）。
所有参与者都有与真实标准化病人接触的经验。最初，虚拟病人正确识别了大约60%的学生问题，并且通过改进虚拟病人回答的脚本深度和可变性提高了大多数错误的语音识别。学生的评价较好，特别是与虚拟指导教师提供的反馈有关。对于1.0版本，学生对虚拟体验的总体评分为6.47±1.63（1分 = 最低，10分 = 最高），4个月后的2.0版本为7.22±1.76，这反映了语音识别和其他技术改进。这些总体评分与真实标准化病人的学生评分为7.47±1.16相比具有优势。
尽管目前存在技术限制，但虚拟临床场景可以为学生提供一个可控、安全的学习环境，有机会在有反馈的情况下进行广泛的重复练习，而不会对真实病人或标准化病人造成影响。
