Hecimovich Mark, Volet Simone
School of Psychology and Exercise Science, Murdoch University, Murdoch, Western Australia.
BMC Med Educ. 2014 Nov 29;14:253. doi: 10.1186/s12909-014-0253-6.
Musculoskeletal disorders and diseases are leading causes of pain, physical disability, and doctor visits throughout the world. Health professionals must be trained to assess, treat through rehabilitation and monitor patients with these disorders. Yet, due to overcrowded curricula, some health education programs struggle to accommodate more than minimal training in musculoskeletal conditions. Consequently, educators in these professions must consider how traditional instruction could be complemented effectively to enhance students' preparation for the diverse musculoskeletal disorders and pathologies they may encounter. The purpose of this study was to explore the benefits that can be obtained from laboratory practice in musculoskeletal conditions with a standardised patient, rather than a peer patient, in a condensed time frame.
Two groups of students were assigned to either a standardised or a peer patient condition for 2 × 2 hours musculoskeletal assessment and rehabilitation lab sessions. All students completed a pre-post matched questionnaire measuring their clinical knowledge, confidence in clinical skills and motivation for further learning. Their clinical skills were tested at the end. Students and standardised patients' perceptions of the simulated learning environment to practise musculoskeletal assessment and rehabilitation were also elicited.
A t-test for independent samples revealed that students working with standardised patients displayed significantly higher standards of practical clinical skills than those working with peer patients (p=0.018). Using MANOVAs with repeated measures, no interaction effect for clinical knowledge, confidence in clinical skills, and motivation for future learning were found, both groups displaying significantly enhanced cognition and motivation. Three positive and two negative themes emerged from the analysis of students' perceptions of the simulated learning environments. These were consistent with the simulated patients' perceptions.
The findings of this study provide support for the value of using standardised patients to enhance clinical skills in musculoskeletal assessment and rehabilitation when the timeframe for laboratory practice is limited. Students' perceptions of their experience contributed to explain why confidence in clinical skills might not necessarily improve when practising with standardised patients. Suggestions are made for optimising learning with standardised patients and for addressing the economic challenge on health education programs of hiring standardised patients.
肌肉骨骼疾病是全球范围内导致疼痛、身体残疾以及就医的主要原因。卫生专业人员必须接受培训，以便对患有这些疾病的患者进行评估、通过康复治疗以及监测。然而，由于课程安排过于紧凑，一些健康教育项目难以提供超出肌肉骨骼疾病最低限度培训的内容。因此，这些专业的教育工作者必须考虑如何有效地补充传统教学，以增强学生应对他们可能遇到的各种肌肉骨骼疾病和病理状况的准备。本研究的目的是探讨在有限的时间内，通过标准化患者而非同伴患者进行肌肉骨骼疾病的实验室实践能够获得的益处。
两组学生被分配到标准化患者或同伴患者条件下，进行2×2小时的肌肉骨骼评估和康复实验室课程。所有学生都完成了一份前后匹配的问卷，测量他们的临床知识、临床技能信心以及进一步学习的动力。最后对他们的临床技能进行了测试。还收集了学生和标准化患者对用于实践肌肉骨骼评估和康复的模拟学习环境的看法。
独立样本t检验显示，与同伴患者一起学习的学生相比，与标准化患者一起学习的学生在实践临床技能方面表现出显著更高的标准（p = 0.018）。使用重复测量的多变量方差分析，未发现临床知识、临床技能信心和未来学习动力的交互作用，两组在认知和动力方面均有显著增强。对学生对模拟学习环境的看法进行分析后出现了三个积极主题和两个消极主题。这些与模拟患者的看法一致。
本研究结果支持在实验室实践时间有限的情况下，使用标准化患者来提高肌肉骨骼评估和康复临床技能的价值。学生对他们经历的看法有助于解释为什么在与标准化患者一起实践时临床技能信心不一定会提高。针对优化与标准化患者的学习以及应对健康教育项目中雇佣标准化患者的经济挑战提出了建议。
