Jacklin Simon, Maskrey Neal, Chapman Stephen
School of Pharmacy and Bioengineering, Keele University, Keele, United Kingdom.
JMIR Med Educ. 2021 Jun 10;7(2):e22745. doi: 10.2196/22745.
Shared decision-making (SDM) is a process in which clinicians and patients work together to select tests, treatments, management, or support packages based on clinical evidence and the patient's informed preferences. Similar to any skill, SDM requires practice to improve. Virtual patients (VPs) are simulations that allow one to practice a variety of clinical skills, including communication. VPs can be used to help professionals and students practice communication skills required to engage in SDM; however, this specific focus has not received much attention within the literature. A multiple-choice VP was developed to allow students the opportunity to practice SDM. To interact with the VP, users chose what they wanted to say to the VP by choosing from multiple predefined options, rather than typing in what they wanted to say.
This study aims to evaluate a VP workshop for medical students aimed at developing the communication skills required for SDM.
Preintervention and postintervention questionnaires were administered, followed by semistructured interviews. The questionnaires provided cohort-level data on the participants' views of the VP and helped to inform the interview guide; the interviews were used to explore some of the data from the questionnaire in more depth, including the participants' experience of using the VP.
The interviews and questionnaires suggested that the VP was enjoyable and easy to use. When the participants were asked to rank their priorities in both pre- and post-VP consultations, there was a change in the rank position of respecting patient choices, with the median rank changing from second to first. Owing to the small sample size, this was not analyzed for statistical significance. The VP allowed the participants to explore a consultation in a way that they could not with simulated or real patients, which may be part of the reason that the VP was suggested as a useful intervention for bridging from the early, theory-focused years of the curriculum to the more patient-focused ones later.
The VP was well accepted by the participants. The multiple-choice system of interaction was reported to be both useful and restrictive. Future work should look at further developing the mode of interaction and explore whether the VP results in any changes in observed behavior or practice.
共同决策（SDM）是一个临床医生和患者共同合作，基于临床证据和患者的知情偏好来选择检查、治疗、管理或支持方案的过程。与任何技能一样，共同决策需要通过练习来提高。虚拟患者（VP）是一种模拟工具，可让人练习包括沟通在内的各种临床技能。虚拟患者可用于帮助专业人员和学生练习共同决策所需的沟通技能；然而，这一特定重点在文献中并未受到太多关注。开发了一个多项选择题形式的虚拟患者，让学生有机会练习共同决策。为了与虚拟患者互动，用户通过从多个预定义选项中选择来决定想对虚拟患者说的话，而不是输入想说的内容。
本研究旨在评估一个针对医学生的虚拟患者工作坊，该工作坊旨在培养共同决策所需的沟通技能。
在干预前和干预后发放问卷，随后进行半结构化访谈。问卷提供了关于参与者对虚拟患者看法的队列水平数据，并有助于为访谈指南提供信息；访谈用于更深入地探讨问卷中的一些数据，包括参与者使用虚拟患者的体验。
访谈和问卷表明，虚拟患者有趣且易于使用。当要求参与者对虚拟患者咨询前后的优先事项进行排序时，尊重患者选择的排名位置发生了变化，中位数排名从第二位升至第一位。由于样本量较小，未对其进行统计学显著性分析。虚拟患者使参与者能够以一种他们无法与模拟患者或真实患者进行的方式探索咨询过程，这可能是虚拟患者被认为是一种有用干预措施的部分原因，它能帮助学生从课程早期以理论为主的阶段过渡到后期更以患者为中心的阶段。
虚拟患者受到参与者的好评。据报道，多项选择互动系统既有用又有局限性。未来的工作应着眼于进一步开发互动模式，并探索虚拟患者是否会导致观察到的行为或实践发生任何变化。
