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利用模拟标准化/模拟患者问诊促进医学生临床能力发展

The Use of Mock Standardized/Simulated Patient Encounters in Facilitating Development of Clinical Competence in Medical Students.

作者信息

Tran Nga N, Thomas Denisia, Haverkamp Chloe F, Leslie Emilee L, Kashmer David

机构信息

Simulation Center, Edward Via College of Osteopathic Medicine, Auburn, USA.

Chair of Surgery & Associate Dean for Simulation, Edward Via College of Osteopathic Medicine, Auburn, USA.

出版信息

Cureus. 2023 Jun 17;15(6):e40562. doi: 10.7759/cureus.40562. eCollection 2023 Jun.

Abstract

Background Standardized patient (SP) encounters are used in medical school to mimic clinical practice by exposing students to possible clinical situations they may encounter in future practice. SP includes trained individuals who portray the roles of patients to help medical students practice recording medical histories, physical exam skills, communication skills, and typing a subjective, objective, assessment and plan (SOAP) note. The goal of SP is to prepare medical students adequately during their didactic years before beginning clerkships. SP encounters have become standard in medical school curriculums, but the option for a mock SP encounter has not.  Methods In this study, a total of 34 participants completed an eight-question survey before a mock SP experience and after their graded SP encounters to assess the students' confidence levels and preparedness. Each question addressed a different aspect of the student's satisfaction and attitude regarding the SP encounters. The answers were measured on a Likert scale from 1 (not prepared) to 5 (very prepared). The central tendency (mean) was analyzed using a T-test with Welch's method. The standard deviation was analyzed using Bonett's test. A Cronbach's alpha was used to show the reliability of the survey used. Results The first four questions addressed the student's satisfaction with their mock SP experience. The mean student satisfaction with being able to ask questions to improve their knowledge and understanding improved, with a p-value of < 0.001. Student satisfaction with having the opportunity to record a patient's history improved, with a p-value of < 0.001. The overall satisfaction with having a chance to practice physical exam skills improved, with a p-value of < 0.001. Mean student satisfaction with practicing treatment and counseling of patients improved, with a p-value of <0.001. The final four questions addressed the students' attitudes regarding their experience. The mean confidence of students improved, with a p-value of <0.001. Students also reported an improved attitude towards the feedback they received, with a p-value of <0.001. The final two questions did not show a statistically significant difference in answers. Students rated the final two questions equally before and after the mock SP experience, with p-values > 0.05. These questions addressed whether mock SP encounters would be beneficial and asked if they wanted additional mock simulation opportunities built into the curriculum. Conclusions The students showed improved confidence, attitudes, and satisfaction surrounding standardized patient encounters. The results supported the hypothesis that there would be a difference between the responses before and after the SP encounter. The questionnaire showed that the students reported subjective changes in their competence following the encounter.

摘要

背景 标准化病人(SP)模拟问诊被用于医学院校,通过让学生接触未来临床实践中可能遇到的情况来模拟临床实际。标准化病人包括经过培训的人员,他们扮演患者角色,以帮助医学生练习记录病史、体格检查技能、沟通技巧以及撰写主观、客观、评估和计划(SOAP)记录。标准化病人模拟问诊的目标是在医学生开始临床实习前的理论学习阶段充分做好准备。标准化病人模拟问诊已成为医学院校课程的标准组成部分,但模拟标准化病人模拟问诊的选择却并非如此。 方法 在本研究中,共有34名参与者在模拟标准化病人体验之前以及在他们分级的标准化病人模拟问诊之后完成了一份包含八个问题的调查问卷,以评估学生的信心水平和准备情况。每个问题涉及学生对标准化病人模拟问诊的满意度和态度的不同方面。答案采用从1(未准备好)到5(准备得非常好)的李克特量表进行衡量。使用带有韦尔奇方法的T检验分析中心趋势(均值)。使用博内特检验分析标准差。使用克朗巴哈系数来显示所使用调查问卷的可靠性。 结果 前四个问题涉及学生对模拟标准化病人体验的满意度。学生对能够提问以增进知识和理解的满意度有所提高,p值<0.001。学生对有机会记录患者病史的满意度有所提高,p值<0.001。对有机会练习体格检查技能的总体满意度有所提高,p值<0.001。学生对练习患者治疗和咨询的满意度有所提高,p值<0.001。最后四个问题涉及学生对其体验的态度。学生的平均信心有所提高,p值<0.001。学生对所收到反馈的态度也有所改善,p值<0.001。最后两个问题在答案上未显示出统计学上的显著差异。学生在模拟标准化病人体验前后对最后两个问题的评分相同,p值>0.05。这些问题涉及模拟标准化病人模拟问诊是否有益,并询问他们是否希望课程中增加额外的模拟机会。 结论 学生在标准化病人模拟问诊方面表现出信心、态度和满意度的提高。结果支持了标准化病人模拟问诊前后回答会存在差异的假设。调查问卷显示,学生在模拟问诊后报告了其能力方面的主观变化。

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