Nguyen Khoa, Ben Khallouq Bertha, Schuster Amanda, Beevers Christopher, Dil Nyla, Kay Denise, Kibble Jonathan D, Harris David M
Department of Medical Education, College of Medicine, University of Central Florida, Orlando, Florida.
Department of Medical Education, College of Medicine, University of Central Florida, Orlando, Florida
Adv Physiol Educ. 2017 Dec 1;41(4):604-611. doi: 10.1152/advan.00126.2017.
Most assessments of physiology in medical school use multiple choice tests that may not provide information about a student's critical thinking (CT) process. There are limited performance assessments, but high-fidelity patient simulations (HFPS) may be a feasible platform. The purpose of this pilot study was to determine whether a group's CT process could be observed over a series of HFPS. An instrument [Critical Thinking Skills Rating Instrument CTSRI)] was designed with the IDEAS framework. Fifteen groups of students participated in three HFPS that consisted of a basic knowledge quiz and introduction, HFPS session, and debriefing. HFPS were video recorded, and two raters reviewed and scored all HFPS encounters with the CTSRI independently. Interrater analysis suggested good reliability. There was a correlation between basic knowledge scores and three of the six observations on the CTSRI providing support for construct validity. The median CT ratings significantly increased for all observations between the groups' first and last simulation. However, there were still large percentages of video ratings that indicated students needed substantial prompting during the HFPS. The data from this pilot study suggest that it is feasible to observe CT skills in HFPS using the CTSRI. Based on the findings from this study, we strongly recommend that first-year medical students be competent in basic knowledge of the relevant physiology of the HFPS before participating, to minimize the risk of a poor learning experience.
医学院校中大多数生理学评估采用多项选择题测试，这种测试可能无法提供有关学生批判性思维（CT）过程的信息。性能评估有限，但高保真患者模拟（HFPS）可能是一个可行的平台。这项初步研究的目的是确定是否可以通过一系列HFPS观察一个小组的CT过程。使用IDEAS框架设计了一种工具[批判性思维技能评分工具CTSRI]。十五组学生参加了三次HFPS，包括基础知识测验和介绍、HFPS环节以及汇报环节。HFPS进行了视频录制，两名评分者独立审查并使用CTSRI对所有HFPS环节进行评分。评分者间分析表明可靠性良好。基础知识得分与CTSRI六项观察结果中的三项之间存在相关性，为结构效度提供了支持。在小组的第一次和最后一次模拟之间，所有观察结果的CT评分中位数显著提高。然而，仍有很大比例的视频评分表明学生在HFPS过程中需要大量提示。这项初步研究的数据表明，使用CTSRI在HFPS中观察CT技能是可行的。基于这项研究的结果，我们强烈建议一年级医学生在参加HFPS之前掌握相关生理学的基础知识，以尽量减少学习体验不佳的风险。
