Department Psychology, Ludwig-Maximilians University Munich, Germany.
Med Educ. 2012 Oct;46(10):1001-8. doi: 10.1111/j.1365-2923.2012.04344.x.
Doctor-patient communication skills are often fostered by using simulations with standardised patients (SPs). The efficiency of such experiences is greater if student observers learn at least as much from the simulation as do students who actually interact with the patient.
This study aimed to investigate whether the type of simulation-based learning (learning by doing versus vicarious learning) and the order in which these activities are carried out (learning by doing → vicarious learning versus vicarious learning → learning by doing) have any effect on the acquisition of knowledge on effective doctor-patient communication strategies. In addition, we wished to examine the extent to which an observation script and a feedback formulation script affect knowledge acquisition in this domain.
The sample consisted of 200 undergraduate medical students (126 female, 74 male). They participated in two separate simulation sessions, each of which was 30 minutes long and was followed by a collaborative peer feedback phase. Half of the students first performed (learning by doing) and then observed (vicarious learning) the simulation, and the other half participated in the reverse order. Knowledge of doctor-patient communication was measured before, between and after the simulations.
Vicarious learning led to greater knowledge of doctor-patient communication scores than learning by doing. The order in which vicarious learning was experienced had no influence. The inclusion of an observation script also enabled significantly greater learning in students to whom this script was given compared with students who were not supported in this way, but the presence of a feedback script had no effect.
Students appear to learn at least as much, if not more, about doctor-patient communication by observing their peers interact with SPs as they do from interacting with SPs themselves. Instructional support for observing simulations in the form of observation scripts facilitates both vicarious learning and learning by doing. An observation script may focus learners' attention on the important aspects of doctor-patient communication and increase the content-related accuracy of peer feedback.
医患沟通技巧通常通过使用标准化患者（SP）进行模拟来培养。如果学生观察员从模拟中至少学到与实际与患者互动的学生一样多的知识，那么这种经验的效率就会更高。
本研究旨在调查基于模拟的学习类型（实践学习与替代学习）以及执行这些活动的顺序（实践学习→替代学习与替代学习→实践学习）是否对有效医患沟通策略知识的获取有任何影响。此外，我们还希望研究观察脚本和反馈制定脚本在多大程度上影响该领域的知识获取。
样本由 200 名本科医学生（126 名女性，74 名男性）组成。他们参加了两个单独的模拟课程，每个课程持续 30 分钟，随后是协作式同伴反馈阶段。一半的学生先进行（实践学习），然后观察（替代学习）模拟，另一半则以相反的顺序参与。在模拟前后测量医患沟通知识。
替代学习比实践学习导致更高的医患沟通得分。体验替代学习的顺序没有影响。包含观察脚本还使获得该脚本的学生比未获得该脚本的学生学习效果更好，但反馈脚本的存在没有影响。
学生通过观察同伴与 SP 互动，至少可以与自己与 SP 互动一样多地学习医患沟通。以观察脚本的形式为观察模拟提供教学支持，可以促进替代学习和实践学习。观察脚本可以使学习者关注医患沟通的重要方面，并提高同伴反馈的内容相关性准确性。
