Uniformed Services University of the Health Sciences, Bethesda, MD, USA.
Acad Psychiatry. 2023 Apr;47(2):181-186. doi: 10.1007/s40596-023-01755-z. Epub 2023 Feb 17.
The Uniformed Services University of the Health Sciences 5-week psychiatry clerkship educates about 180 students a year at sites around the USA. In 2017, weekly in-person experiential learning sessions were implemented for local students and resulted in improved performance in several end-of-clerkship Objective Structured Clinical Examination (OSCE) skills as compared to distant learners who did not receive these sessions. The difference in performance (~ 10%) highlighted a need to provide comparable training for distant learners. Providing in-person, repeated simulated experiential training at multiple distant sites was not practical, requiring development of a novel online approach.
Students at all four distant sites over 2 years (n = 180) participated in five weekly synchronous online experiential learning sessions, while local students (n = 180) received five weekly in-person experiential learning sessions. Tele-simulation used the same curriculum, centralized faculty, and standardized patients as the in-person iterations. Overall end-of-clerkship OSCE performance was compared for learners receiving online versus in-person experiential learning for non-inferiority. Specific skills were compared to receiving no experiential learning.
Overall OSCE performance was non-inferior for students who received synchronous online as compared to in-person experiential learning. Performance on each skill other than communication improved significantly when comparing students who received online versus no experiential learning (p < 0.05).
The use of weekly online experiential learning to enhance clinical skills is comparable to in-person efforts. Virtual, simulated, synchronous experiential learning provides a feasible and scalable platform for training complex clinical skills to clerkship students, a critical capability given the impact the pandemic has had on clinical training.
美国卫生科学统一服务大学的 5 周精神病学实习课程每年在全美各地的多个地点为约 180 名学生提供教育。2017 年，为当地学生实施了每周一次的实地体验式学习课程，与未参加这些课程的远程学习者相比，这些课程使多项实习结束时客观结构化临床考试（OSCE）技能的表现得到了提高。与远程学习者相比，表现上的差异（约 10%）突出表明需要为远程学习者提供可比的培训。在多个远程地点提供实地、重复的模拟体验式培训是不切实际的，因此需要开发一种新的在线方法。
在 2 年的时间里，所有四个远程地点的学生（n=180）都参加了每周五次的同步在线体验式学习课程，而当地学生（n=180）则参加了每周五次的实地体验式学习课程。远程模拟使用了与实地迭代相同的课程、集中的教师和标准化患者。对于接受在线和实地体验式学习的学习者，比较了整个实习结束时的 OSCE 表现，以确定非劣效性。将特定技能与未接受体验式学习的情况进行了比较。
接受同步在线体验式学习的学生的 OSCE 总体表现与接受实地体验式学习的学生相当。与接受无体验式学习的学生相比，在比较接受在线与无体验式学习的学生时，每个技能（除了沟通技能）的表现都显著提高（p<0.05）。
使用每周在线体验式学习来提高临床技能与实地培训效果相当。虚拟、模拟、同步体验式学习为实习学生提供了一种可行且可扩展的平台，用于培训复杂的临床技能，鉴于大流行对临床培训的影响，这是一项关键能力。
