Office of Undergraduate Medical Education, University of Calgary, Calgary, Alberta, Canada.
Acad Med. 2010 Jan;85(1):155-8. doi: 10.1097/ACM.0b013e3181c4f8bf.
The challenge of planning a clinical clerkship curriculum is to create order from chaos. Fortunately, the Liaison Committee for Medical Education has thrown clerkship directors a lifeline by recognizing simulated learning experiences--including virtual patients--as equivalents to real-life clinical encounters for accreditation purposes. Although virtual patients offer a more consistent and learner-centered curriculum that provides greater practice opportunities and reduces the demand for busy clinical preceptors, going virtual does involve potential risks. Here, the authors discuss some of the pros and cons of virtual patients, especially the concerns that virtual learning experiences may not produce effective feedback and that learning may not transfer from the virtual to the clinical environment. To match teaching to different learning needs, the authors propose "adaptive feedback" whereby learners choose from three levels of feedback: seeing the correct diagnosis and patient outcomes, seeing an expert "trace," and/or meeting with their preceptor to discuss the case. Medical educators can facilitate automatic transfer of learning from the virtual to the clinical setting by making all aspects of the learning and retrieval environments as similar as possible and by integrating the virtual and clinical environments--thus sparing learners the burden of "forward reaching" transfer and providing an anchor for virtual learning experiences. Medical educators can promote intentional transfer of learning if they make the virtual learning environment both the place students practice their skills before clinical encounters and the place to which they return after clinical encounters to reflect on and improve their skills.
规划临床实习课程的挑战在于从混乱中创造秩序。幸运的是，医学教育联络委员会通过承认模拟学习体验——包括虚拟患者——在认证目的上等同于真实的临床接触，为实习主任提供了一条生命线。尽管虚拟患者提供了更一致、更以学习者为中心的课程，提供了更多的实践机会，并减少了对忙碌的临床导师的需求，但走向虚拟确实涉及潜在的风险。在这里，作者讨论了虚拟患者的一些优缺点，特别是虚拟学习体验可能无法提供有效反馈以及学习可能无法从虚拟环境转移到临床环境的问题。为了根据不同的学习需求进行教学，作者提出了“自适应反馈”，即学习者可以从三个反馈级别中进行选择：看到正确的诊断和患者结果、看到专家的“痕迹”，和/或与他们的导师讨论病例。医学教育者可以通过使学习和检索环境的所有方面尽可能相似，并通过整合虚拟和临床环境，为学习者减轻“向前延伸”转移的负担，并为虚拟学习体验提供一个锚点，从而促进从虚拟到临床环境的学习自动转移。如果医学教育者使虚拟学习环境成为学生在临床接触前练习技能的地方，以及他们在临床接触后返回的地方，以反思和提高技能，那么他们可以促进学习的有意转移。
