形成性客观结构化临床考试中的反馈：直接观察与基于视频形式的比较。
Feedback in formative OSCEs: comparison between direct observation and video-based formats.
作者信息
Junod Perron Noëlle, Louis-Simonet Martine, Cerutti Bernard, Pfarrwaller Eva, Sommer Johanna, Nendaz Mathieu
机构信息
Unit of Development and Research in Medical Education, Faculty of Medicine, University of Geneva, Geneva, Switzerland.
Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergencies, Geneva University Hospitals, Geneva, Switzerland;
出版信息
Med Educ Online. 2016 Nov 8;21:32160. doi: 10.3402/meo.v21.32160. eCollection 2016.
INTRODUCTION
Medical students at the Faculty of Medicine, University of Geneva, Switzerland, have the opportunity to practice clinical skills with simulated patients during formative sessions in preparation for clerkships. These sessions are given in two formats: 1) direct observation of an encounter followed by verbal feedback (direct feedback) and 2) subsequent review of the videotaped encounter by both student and supervisor (video-based feedback). The aim of the study was to evaluate whether content and process of feedback differed between both formats.
METHODS
In 2013, all second- and third-year medical students and clinical supervisors involved in formative sessions were asked to take part in the study. A sample of audiotaped feedback sessions involving supervisors who gave feedback in both formats were analyzed (content and process of the feedback) using a 21-item feedback scale.
RESULTS
Forty-eight audiotaped feedback sessions involving 12 supervisors were analyzed (2 direct and 2 video-based sessions per supervisor). When adjusted for the length of feedback, there were significant differences in terms of content and process between both formats; the number of communication skills and clinical reasoning items addressed were higher in the video-based format (11.29 vs. 7.71, 0.002 and 3.71 vs. 2.04, 0.010, respectively). Supervisors engaged students more actively during the video-based sessions than during direct feedback sessions (self-assessment: 4.00 vs. 3.17, 0.007; active problem-solving: 3.92 vs. 3.42, 0.009). Students made similar observations and tended to consider that the video feedback was more useful for improving some clinical skills.
CONCLUSION
Video-based feedback facilitates discussion of clinical reasoning, communication, and professionalism issues while at the same time actively engaging students. Different time and conceptual frameworks may explain observed differences. The choice of feedback format should depend on the educational goal.
引言
瑞士日内瓦大学医学院的医学生有机会在实习准备阶段的形成性课程中与模拟患者练习临床技能。这些课程有两种形式：1）直接观察一次问诊，随后进行口头反馈（直接反馈）；2）学生和督导员随后一起观看问诊录像（基于视频的反馈）。本研究的目的是评估两种形式的反馈在内容和过程上是否存在差异。
方法
2013年，所有参与形成性课程的二、三年级医学生和临床督导员都被邀请参加该研究。使用一个包含21个项目的反馈量表，对涉及以两种形式提供反馈的督导员的录音反馈课程样本（反馈的内容和过程）进行了分析。
结果
分析了涉及12名督导员的48次录音反馈课程（每位督导员2次直接反馈课程和2次基于视频的课程）。在对反馈时长进行调整后，两种形式在内容和过程方面存在显著差异；基于视频的形式中涉及的沟通技能和临床推理项目数量更多（分别为11.29对7.71，P = 0.002；3.71对2.04，P = 0.010）。与直接反馈课程相比，督导员在基于视频的课程中与学生的互动更积极（自我评估：4.00对3.17，P = 0.007；积极解决问题：3.92对3.42，P = 0.009）。学生也有类似的观察结果，并倾向于认为视频反馈对提高某些临床技能更有用。
结论
基于视频的反馈有助于讨论临床推理、沟通和专业素养问题，同时能让学生更积极地参与。不同的时间和概念框架可能解释了观察到的差异。反馈形式的选择应取决于教育目标。
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