Department of Educational Development and Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Acad Med. 2010 Jan;85(1):148-54. doi: 10.1097/ACM.0b013e3181c48130.
Few studies have compared the instructiveness of real patient contacts with simulated patient (SP) contacts. Although most of these studies found no difference, students often comment that the instructiveness of both encounters is dissimilar. The aims of this study were to evaluate which contact (real patient or SP) is perceived as most instructive by students and which variables contribute to this.
The authors performed an experiment involving 163 first-year medical students, randomized to having a real patient contact (n = 61) or SP contact (n = 102). Quantitative (questionnaires) and qualitative (focus groups) methods were used to evaluate the perceived instructiveness of the contact.
The general instructiveness of both real patient contacts and SP contacts was marked high. Several differences between the evaluations of real patient contacts and SP contacts were found. For example, students considered real patient contacts less helpful in practicing communication skills and considered the real patients' feedback less relevant. The focus group interviews yielded explanations for many of the differences found. Students regarded real patients as more authentic. However, SPs were better informed about the purpose of the consultation and provided the student with more specific feedback.
Students consider authenticity an important advantage of real patients. Their difficult recruitment is an important disadvantage, however, SPs have important advantages compared with real patients--for example, their feedback. The choice of real patient contacts or SP contacts for medical education depends on factors like the phase of the curriculum and the aim of the encounter.
很少有研究比较真实患者接触和模拟患者（SP）接触的指导意义。尽管大多数研究没有发现差异，但学生们经常评论说，这两种接触的指导意义是不同的。本研究旨在评估学生认为哪种接触（真实患者或 SP）最具指导意义，以及哪些变量对此有影响。
作者进行了一项涉及 163 名一年级医学生的实验，将学生随机分为真实患者接触组（n = 61）或 SP 接触组（n = 102）。采用定量（问卷）和定性（焦点小组）方法评估接触的感知指导意义。
真实患者接触和 SP 接触的总体指导意义都很高。在真实患者接触和 SP 接触的评估之间发现了一些差异。例如，学生认为真实患者接触对练习沟通技巧帮助不大，认为真实患者的反馈不太相关。焦点小组访谈为发现的许多差异提供了解释。学生认为真实患者更真实。然而，SP 对咨询目的的了解更为准确，并为学生提供了更具体的反馈。
学生认为真实性是真实患者的一个重要优势。然而，他们的招募困难是一个重要的劣势，而 SP 与真实患者相比具有重要的优势，例如他们的反馈。选择真实患者接触或 SP 接触进行医学教育取决于课程阶段和接触目的等因素。
