From Jump Simulation (W.F.B., M.J.M., T.J.L., R.E.A., K.M.M., and M.A.), a collaboration of OSF Healthcare and the University of Illinois College of Medicine at Peoria; the Department of Internal Medicine (T.J.L., M.J.M., M.A.), Department of Pediatrics (T.J.L., M.J.M), and Department of Emergency Medicine (W.F.B) University of Illinois College of Medicine at Peoria; and Department of Medical Education (Y.S.P.), University of Illinois College of Medicine at Chicago, Chicago, IL.
Simul Healthc. 2023 Jun 1;18(3):147-154. doi: 10.1097/SIH.0000000000000659. Epub 2022 Mar 25.
This study examined the influence of high value care (HVC)-focused virtual standardized patients (VSPs) on learner attitudes toward cost-conscious care (CCC), performance on subsequent standardized patient (SP) encounters, and the correlation of VSP performance with educational outcomes.
After didactic sessions on HVC, third-year medical students participated in a randomized crossover design of simulation modalities consisting of 4 VSPs and 3 SPs. Surveys of attitudes toward CCC were administered before didactics and after the first simulation method. Performance markers included automated VSP grading and, for SP cases, faculty-graded observational checklists and patient notes. Performance was compared between modalities using t tests and analysis of variance and then correlated with US Medical Licensing Examination performance.
Sixty-six students participated (VSP first: n = 37; SP-first: n = 29). Attitudes toward CCC significantly improved after training (Cohen d = 0.35, P = 0.043), regardless of modality. Simulation order did not impact learner performance for SP encounters. Learners randomized to VSP first performed significantly better within VSP cases for interview (Cohen d = 0.55, P = 0.001) and treatment (Cohen d = 0.50, P = 0.043). The HVC component of learner performance on the SP simulations significantly correlated with US Medical Licensing Examination step 1 ( r = 0.26, P = 0.038) and step 2 clinical knowledge ( r = 0.33, P = 0.031).
High value care didactics combined with either VSPs or SPs positively influenced attitudes toward CCC. The ability to detect an impact of VSPs on learner SP performance was limited by content specificity and sample size.
本研究考察了高价值医疗（HVC）为重点的虚拟标准化患者（VSP）对学习者成本意识护理（CCC）态度、后续标准化患者（SP）接触表现的影响，以及 VSP 表现与教育成果的相关性。
在 HVC 教学课程之后，三年级医学生参与了模拟模式的随机交叉设计，包括 4 个 VSP 和 3 个 SP。在教学前和第一次模拟方法后进行了 CCC 态度调查。绩效指标包括自动化 VSP 评分，以及对于 SP 病例，教师评分观察检查表和患者记录。使用 t 检验和方差分析比较不同模式下的绩效，然后与美国医师执照考试（USMLE）成绩相关联。
共有 66 名学生参与（VSP 第一：n = 37；SP 第一：n = 29）。无论模式如何，培训后 CCC 态度显著改善（Cohen d = 0.35，P = 0.043）。模拟顺序对 SP 接触的学习者表现没有影响。随机分配到 VSP 第一的学习者在 VSP 病例中的访谈（Cohen d = 0.55，P = 0.001）和治疗（Cohen d = 0.50，P = 0.043）表现显著更好。学习者在 SP 模拟中的 HVC 表现与 USMLE 步骤 1（r = 0.26，P = 0.038）和步骤 2 临床知识（r = 0.33，P = 0.031）显著相关。
HVC 教学与 VSP 或 SP 结合使用均能积极影响 CCC 态度。由于内容特异性和样本量的限制，检测 VSP 对学习者 SP 表现的影响的能力有限。
