Dr. Räder is a fellow in cardiology, Centre for Clinical Education, University of Copenhagen and Capital Region, Copenhagen, Denmark. Ms. Henriksen is advisor/consultant, Centre for Clinical Education, University of Copenhagen and Capital Region, Copenhagen, Denmark. Dr. Butrymovich is a cardiologist, Cardiac Catheterization Laboratory, Department of Cardiology, University Hospital Rigshospitalet, Copenhagen, Denmark. Dr. Sander is a cardiologist, Cardiac Catheterization Laboratory, Department of Cardiology, University Hospital Rigshospitalet, Copenhagen, Denmark. Dr. Jørgensen is a cardiologist, Cardiac Catheterization Laboratory, Department of Cardiology, University Hospital Rigshospitalet, Copenhagen, Denmark. Dr. Lönn is professor, Departments of Vascular Surgery and Radiology, University Hospital Rigshospitalet, Copenhagen, Denmark. Dr. Ringsted is professor, Department of Anesthesia, director and scientist, Wilson Centre, and BMO chair in health professions education research, University of Toronto and University Health Network, Toronto, Ontario, Canada.
Acad Med. 2014 Sep;89(9):1287-94. doi: 10.1097/ACM.0000000000000373.
The aims of this study were (1) to explore the effectiveness of dyad practice compared with individual practice on a simulator for learning a complex clinical skill and (2) to explore medical students' perceptions of how and why dyad practice on a simulator contributes to learning a complex skill.
In 2011, the authors randomly assigned 84 medical students to either the dyad or the individual practice group to learn coronary angiography skills using instruction videos and a simulator. Two weeks later, participants each performed two video-recorded coronary angiographies on the simulator. Two raters used a rating scale to assess the participants' video-recorded performance. The authors then interviewed the participants in the dyad practice group.
Seventy-two (86%) participants completed the study. The authors found no significant difference between the performance scores of the two groups (mean±standard deviation, 68%±13% for individual versus 63%±16% for dyad practice; P=.18). Dyad practice participants noted that several key factors contributed to their learning: being equal-level novices, the quality of the cooperation between partners, observational learning and overt communication, social aspects and motivation, and meta-cognition.
Dyad practice is more efficient and thus more cost-effective than individual practice and can be used for costly virtual reality simulator training. However, dyad practice may not apply to clinical training involving real patients because learning from errors and overt communication, both keys to dyad practice, do not transfer to clinical practice.
本研究旨在（1）探讨在模拟器上进行双人实践与单人实践相比对学习复杂临床技能的效果，以及（2）探讨医学生对在模拟器上进行双人实践如何促进复杂技能学习的看法和原因。
2011 年，作者将 84 名医学生随机分配到双人或单人实践组，使用教学视频和模拟器学习冠状动脉造影技能。两周后，参与者在模拟器上各进行两次录像冠状动脉造影。两名评估员使用评分量表评估参与者的录像表现。然后，作者对双人实践组的参与者进行了访谈。
72 名（86%）参与者完成了研究。作者未发现两组表现评分之间存在显著差异（单人实践组的平均得分±标准差为 68%±13%，双人实践组为 63%±16%；P=.18）。双人实践组的参与者指出，有几个关键因素促成了他们的学习：同为新手水平、合作伙伴之间合作的质量、观察学习和公开交流、社交方面和动机以及元认知。
与单人实践相比，双人实践更高效，因此更具成本效益，可用于昂贵的虚拟现实模拟器培训。然而，双人实践可能不适用于涉及真实患者的临床培训，因为从错误中学习和公开交流这两个双人实践的关键因素都无法转移到临床实践中。
