S. Kim is associate clerkship director, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. L.R. Willett is subinternship director and associate residency program director, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. W.J. Pan is clerkship director, Department of Pediatrics, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. J. Afran is clerkship director, Department of Family Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. J.A. Walker is associate dean for faculty affairs and vice chair of education, Department of Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey. J.A. Shea is associate dean of medical education research, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Acad Med. 2018 May;93(5):742-749. doi: 10.1097/ACM.0000000000001961.
To explore how students use and benefit from virtual patient cases (VPCs).
In academic years 2013-2014 and 2014-2015, cohorts of students in pediatrics (Peds), family medicine (FM), and internal medicine (IM) clerkships were allocated to either core required use (CRU) or self-directed use (SU) of MedU VPCs. Outcomes included number and time of case review, student perception of learning from VPCs, National Board of Medical Examiners (NBME) subject examination scores, and summative clinical ratings for medical knowledge and differential diagnoses/problem solving. Focus groups were conducted each year. Mean differences were compared by t test.
A total of 255 students participated in the study. Mean number of cases completed by the CRU group was significantly higher than that by the SU group (13.9 vs. 3.1 for FM, 16.1 vs. 3.9 for Peds, and 10.4 vs. 1.2 for IM) (P < .001). Student-perceived value ratings of VPCs were similar between groups. Students described VPCs as time consuming but useful for supplementing clinical conditions not seen in person. Mean scores on NBME subject examinations for CRU versus SU groups were not different between groups in any clerkship, nor were there significant differences in the summative clinical ratings for medical knowledge or differential diagnosis/clinical reasoning.
Although VPCs continue to serve an important role in exposing students to clinical conditions not seen in person, the optimal employment of this technology in clerkship pedagogy requires further exploration.
探讨学生如何使用和受益于虚拟患者病例（VPC）。
在 2013-2014 学年和 2014-2015 学年，儿科（Peds）、家庭医学（FM）和内科（IM）实习的学生被分配到核心必需使用（CRU）或自我指导使用（SU）MedU VPC。结果包括案例复习的次数和时间、学生对 VPC 学习的感知、美国医师执照考试委员会（NBME）科目考试成绩以及医学知识和鉴别诊断/问题解决的综合临床评分。每年进行焦点小组讨论。采用 t 检验比较均值差异。
共有 255 名学生参与了研究。CRU 组完成的病例数明显高于 SU 组（FM 分别为 13.9 比 3.1，儿科分别为 16.1 比 3.9，内科分别为 10.4 比 1.2）（P <.001）。两组学生对 VPC 的价值评价相似。学生们表示 VPC 虽然耗时，但对于补充个人临床经验中未遇到的情况非常有用。CRU 组与 SU 组的 NBME 科目考试平均成绩在任何实习阶段均无差异，医学知识或鉴别诊断/临床推理的综合临床评分也无显著差异。
尽管 VPC 继续在使学生接触个人临床经验中未遇到的情况方面发挥着重要作用，但在实习教学中更有效地利用这一技术还需要进一步探索。
