Chen Yun-Chang, Cheng Ming-Tai, Lin Chien-Hao, Shih Fuh-Yuan, Chou Wei-Kuo
National Taiwan University Hospital Yunlin Branch Department of Emergency Medicine Yunlin Taiwan.
National Taiwan University Hospital Department of Emergency Medicine Taipei Taiwan.
J Acute Med. 2022 Mar 1;12(1):23-28. doi: 10.6705/j.jacme.202203_12(1).0003.
Disasters cannot be predicted, so being well-prepared is important before a disaster strike. Good preparation needs constant practice and improvement, and full-scale exercise can provide both. The standardized patients (SPs) in a full-scale exercise to simulate patients are vital because they can provide realistic effects to exercise participants. However, there was no literature about who is capable of being an SP. We investigated the relationship between the SPs' current occupation and previous experience with their fidelity and participants' performance.
Three identically designed full-scale exercises were conducted for three different emergency medical teams (EMTs) with the scenario of post-earthquake mass casualty incidents. Forty SPs were used in each exercise. Exercise objective and detail scenario were told to the SPs before exercise, and mock wound makeup was applied to the SPs. Each SP's occupation and previous experience were recorded before exercise. The SP's previous experience was defined as previous exercise experience and previous disaster medicine education. The SPs' fidelity (SPF) was rated using a 5-point Likert scale (1 = poor and 5 = excellent). The participants' performance (PP) was also rated using a 5-point Likert scale (1 = poor and 5 = excellent) according to the accuracy of each SP's triage result and management. The SPF and the PP were evaluated by clinicians with disaster medicine specialties using the same standard. The relationship between the SPs' occupation and the SPF along with occupation, and the PP were analyzed by analysis of variance (ANOVA). The data of the SPF and the PP in the SP groups divided by previous experience were analyzed by the Student's -test.
The SPs' occupations were medical student, nurse, physician, and members of EMT. There was no significant difference in the SPF and the PP between occupations ( = 0.382 and 0.416, respectively). Both the experienced and the inexperienced SP groups show no significant difference in the SPF ( = 0.339). Significantly better PP was noted in the inexperienced SP group ( < 0.001).
The SPs' background does not influence the performance of either SPs or exercise participants. We proposed that the success of using freshmen as SPs in full-scale exercise depends on the pre-exercise design and the SP instruction and training.
灾难无法预测，因此在灾难发生前做好充分准备很重要。良好的准备需要不断练习和改进，而全面演练可以兼顾两者。在模拟患者的全面演练中，标准化病人（SP）至关重要，因为他们能为演练参与者提供逼真的效果。然而，尚无关于谁有能力成为标准化病人的文献。我们研究了标准化病人的当前职业和既往经历与其逼真度及参与者表现之间的关系。
针对三支不同的紧急医疗团队（EMT）进行了三次设计相同的全面演练，演练场景为地震后大规模伤亡事件。每次演练使用40名标准化病人。在演练前向标准化病人告知演练目标和详细场景，并为其进行模拟伤口化妆。在演练前记录每名标准化病人的职业和既往经历。标准化病人的既往经历定义为既往演练经历和既往灾难医学教育经历。使用5分制李克特量表（1 = 差，5 = 优）对标准化病人的逼真度（SPF）进行评分。根据每名标准化病人的分诊结果和处理的准确性，也使用5分制李克特量表（1 = 差，5 = 优）对参与者的表现（PP）进行评分。由具有灾难医学专业的临床医生使用相同标准对标准化病人的逼真度和参与者的表现进行评估。通过方差分析（ANOVA）分析标准化病人的职业与标准化病人逼真度以及职业与参与者表现之间的关系。对按既往经历划分的标准化病人组中的标准化病人逼真度和参与者表现数据进行t检验分析。
标准化病人的职业有医学生、护士、医生和紧急医疗团队成员。不同职业之间的标准化病人逼真度和参与者表现无显著差异（分别为P = 0.382和0.416）。有经验和无经验的标准化病人组在标准化病人逼真度方面均无显著差异（P = 0.339）。无经验的标准化病人组的参与者表现明显更好（P < 0.001）。
标准化病人的背景不影响标准化病人或演练参与者的表现。我们提出，在全面演练中使用新生作为标准化病人取得成功取决于演练前的设计以及对标准化病人的指导和培训。
