Mutter Mary Kathryn, Martindale James R, Shah Neeral, Gusic Maryellen E, Wolf Stephen J
Department of Emergency Medicine, University of Virginia School of Medicine, PO Box 800699, Charlottesville, VA 22908-0699 USA.
University of Virginia School of Medicine, Box 800866 Suite 2008 Pinn Hall, Charlottesville, VA 22908-0866 USA.
Med Sci Educ. 2020 Jan 10;30(1):307-313. doi: 10.1007/s40670-019-00904-0. eCollection 2020 Mar.
Situativity theory posits that learning and the development of clinical reasoning skills are grounded in context. In case-based teaching, this context comes from recreating the clinical environment, through emulation, as with manikins, or description. In this study, we sought to understand the difference in student clinical reasoning abilities after facilitated patient case scenarios with or without a manikin.
Fourth-year medical students in an internship readiness course were randomized into patient case scenarios without manikin (control group) and with manikin (intervention group) for a chest pain session. The control and intervention groups had identical student-led case progression and faculty debriefing objectives. Clinical reasoning skills were assessed after the session using a 64-question script concordance test (SCT). The test was developed and piloted prior to administration. Hospitalist and emergency medicine faculty responses on the test items served as the expert standard for scoring.
Ninety-six students were randomized to case-based sessions with ( = 48) or without ( = 48) manikin. Ninety students completed the SCT (with manikin = 45, without manikin = 45). A statistically significant mean difference on test performance between the two groups was found ( = 3.059, df = 88, = .003), with the manikin group achieving higher SCT scores.
Use of a manikin in simulated patient case discussion significantly improves students' clinical reasoning skills, as measured by SCT. These results suggest that using a manikin to simulate a patient scenario situates learning, thereby enhancing skill development.
情境理论认为，学习和临床推理技能的发展基于情境。在基于案例的教学中，这种情境来自于通过模拟（如使用人体模型）或描述来重现临床环境。在本研究中，我们试图了解在有或没有人体模型辅助的患者案例情景教学后，学生临床推理能力的差异。
将参加实习准备课程的四年级医学生随机分为无人体模型的患者案例情景组（对照组）和有人体模型的患者案例情景组（干预组），进行胸痛课程学习。对照组和干预组的案例推进均由学生主导，教师的总结目标相同。课程结束后，使用一份64道题的脚本一致性测试（SCT）评估临床推理技能。该测试在实施前已开发并进行了预试验。医院医生和急诊医学教师对测试项目的回答作为评分的专家标准。
96名学生被随机分配到有（n = 48）或无（n = 48）人体模型的案例教学课程中。90名学生完成了SCT（有人体模型组 = 45名，无人体模型组 = 45名）。发现两组在测试成绩上存在统计学显著差异（t = 3.059，自由度 = 88，p = 0.003），人体模型组的SCT得分更高。
通过SCT测量发现，在模拟患者案例讨论中使用人体模型可显著提高学生的临床推理技能。这些结果表明，使用人体模型模拟患者情景可使学习情境化，从而促进技能发展。
