Department of Medicine, The Robert Larner, MD College of Medicine, University of Vermont, Burlington VT, USA.
Office of Medical Education, The Robert Larner, MD College of Medicine, University of Vermont, Burlington, VT, USA.
J Addict Dis. 2024 Jul-Sep;42(3):264-269. doi: 10.1080/10550887.2023.2210018. Epub 2023 May 18.
It is crucial that future physicians understand the nature of opioid use disorder (OUD). We designed a pilot Observed Structured Clinical Examination (OSCE) using simulated patients (SPs) experiencing OUD with concurrent chronic pain. The case was piloted in 2021 and 2022 during the multi-station OSCE that all the medical school clerkship students take at the end of their third year of medical school. A total of 111 medical students completed the OSCE in 2021 and 93 in 2022. The authors developed a case description and an assessment instrument for the SP to evaluate the student's performance on history taking, communication and professionalism. The evaluation was mixed-methods using SP evaluation data and a qualitative assessment of medical students' answers to 4 questions which were analyzed with a priori codes. In both years, the total scores for the case were slightly slower than the established OSCE cases in both years. A total of 75% (148/197) of students who responded to the assessment found the case difficult to manage. Strengths of the case included a majority of the students reporting the case helped them to identify strengths and weakness in assessing and treating OUD. Weaknesses included the lack of enough patient history and the perception that the SP was unrealistic (too nice). This pilot OSCE was challenging for the third year medical students based on the evaluative data. Given the scope of OUD and deaths, training students to identify and treat OUD during undergraduate medical education is of paramount importance.
未来的医生必须了解阿片类药物使用障碍（OUD）的性质。我们设计了一个使用患有并发慢性疼痛的 OUD 模拟患者（SP）的试点观察结构化临床检查（OSCE）。该病例于 2021 年和 2022 年在多站 OSCE 中进行了试点，所有医学院实习学生在第三年结束时都要参加该 OSCE。共有 111 名医学生在 2021 年完成了 OSCE，93 名在 2022 年完成了 OSCE。作者为 SP 编写了病例描述和评估工具，以评估学生在病史采集、沟通和专业精神方面的表现。评估采用混合方法，使用 SP 评估数据和对医学生对 4 个问题的回答的定性评估，这些问题使用预先确定的代码进行分析。在这两年中，该病例的总分数略低于这两年既定的 OSCE 病例。共有 75%（148/197）对评估做出回应的学生认为该病例难以管理。该病例的优点包括大多数学生报告该病例有助于他们识别评估和治疗 OUD 的优势和劣势。缺点包括缺乏足够的病史和认为 SP 不现实（太好了）。根据评估数据，这个试点 OSCE 对三年级医学生来说具有挑战性。鉴于 OUD 的范围和死亡人数，在本科医学教育中培训学生识别和治疗 OUD 至关重要。
