Witheridge Annamaria, Ferns Gordon, Scott-Smith Wesley
Cranfield Defence and Security, Cranfield University, Shrivenham, Swindon, SN6 8LA, UK.
Division of Medical Education, Brighton & Sussex Medical School, Falmer, Brighton, UK.
Int J Med Educ. 2019 Aug 29;10:163-171. doi: 10.5116/ijme.5d5a.77af.
The aim was to explore the experiences of fourth-year medical students of diagnostic consultations in a simulated primary care setting, in order to gain an insight into the suitability of such simulated consultations for assessing the diagnostic reasoning skills of medical students.
This single-centre study employed a qualitative, cross-sectional design. Twelve fourth-year medical students volunteered to be filmed across 21 simulated, primary care consultations. The setting closely resembled OSCE stations, with a clinician present at each station monitoring the students' performance using a station-checklist. Upon completion of each station, participants reflected on their experiences using video-stimulated recall. Interviews were transcribed and analysed using Interpretative Phenomenological Analysis.
The simulated scenarios were often perceived to have limited fidelity with predictable outcomes. At times, preoccupation with the assessment checklist meant that students were more likely to focus on asking questions than interpreting the information they were gaining. Some students felt scrutinized during the consultations, while others struggled to adapt to the time pressure. Overall, the artificial setting seemed to promote a reductionist diagnostic approach and an attitude of 'ticking boxes' rather than engaging in active diagnostic reasoning.
The present findings call into question the assumption that observation-based assessment of the performance of medical students during simulated consultations can be reliably used to assess their diagnostic skills. Future studies need to explore how current assessment modalities could be better adapted to facilitate active engagement in diagnostic reasoning.
旨在探究四年级医学生在模拟初级保健环境中进行诊断咨询的体验，以便深入了解此类模拟咨询对于评估医学生诊断推理技能的适用性。
这项单中心研究采用了定性的横断面设计。12名四年级医学生自愿参与了21次模拟初级保健咨询的拍摄。该场景与客观结构化临床考试（OSCE）站点极为相似，每个站点都有一名临床医生在场，使用站点检查表监测学生的表现。每个站点结束后，参与者通过视频刺激回忆反思自己的经历。访谈内容经转录后采用解释现象学分析方法进行分析。
模拟场景通常被认为逼真度有限，结果具有可预测性。有时，对评估检查表的过度关注意味着学生更倾向于专注提问，而非解读所获取的信息。一些学生在咨询过程中感觉受到审视，而另一些学生则难以适应时间压力。总体而言，这种人为设置似乎促使了一种简化的诊断方法和“打勾”态度，而非积极参与诊断推理。
目前的研究结果对以下假设提出了质疑，即基于观察对医学生在模拟咨询中的表现进行评估可可靠地用于评估他们的诊断技能。未来的研究需要探索如何更好地调整当前的评估方式，以促进积极参与诊断推理。
