标准化患者(SP)几十年来一直是临床教学中流行的评估方法之一,尽管它们是资源密集型的。如今,模拟虚拟患者(VP)越来越多地使用,因为它们是永久可用的,并且可以完全扩展到大量受众。然而,缺乏比较这些评估方法不同效果的实证研究。同样,与诊断能力相关的关键变量之间的关系(即,诊断准确性和证据生成)在这些评估方法中仍需要进一步研究。
这项研究的目的是比较感知的真实性,认知负荷,以及使用SP和VPs进行基于绩效的评估的诊断能力。本研究还旨在检验感知真实性之间的关系,认知负荷,和诊断准确性的证据生成质量。
我们对86名医学生进行了一项实验研究(平均26.03年,SD4.71)着重于呼吸困难病例的病史。在这项重复测量研究中,参与者解决了三例SP和三例VP。在每个案例之后,学生提供了诊断,并对感知的真实性和认知负荷进行了评级。根据诊断准确性对提供的诊断进行评分;医学生提出的问题根据其证据生成质量进行评级。除了常规的零假设测试,这项研究使用等效性测试来调查是否存在有意义的效应.
SPs的感知真实性(单尾t81=11.12;P<.001)高于VPs。诊断准确性和感知真实性之间的相关性非常小(r=0.05),既不相等(P=.09)也不具有统计学意义(P=.32)。认知负荷在两种评估方法中相当(t82=2.81;P=0.003)。内在认知负荷(1尾r=-0.30;P=.003)和外来负荷(1尾r=-0.29;P=.003)与诊断准确性的综合评分呈负相关。证据生成的质量与VPs的诊断准确性呈正相关(1尾r=0.38;P<.001);这一发现对SPs无效(1尾r=0.05;P=.32)。比较两种评估方法,SPs的诊断准确率高于VPs(双尾t85=2.49;P=0.01).
关于感知真实性的结果表明,学习者体验到的SPs比VPs更真实。由于较高数量的内在和外来认知负荷对表现有害,两种类型的认知负荷都必须在评估中进行系统的监测和操纵。SPs的诊断准确性高于VPs,这可能会对VPs的学生成绩产生负面影响。我们确定并讨论了两种评估方法之间存在这种性能差异的可能原因。
Standardized patients (SPs) have been one of the popular assessment methods in clinical teaching for decades, although they are resource intensive. Nowadays, simulated virtual patients (VPs) are increasingly used because they are permanently available and fully scalable to a large audience. However, empirical studies comparing the differential effects of these assessment methods are lacking. Similarly, the relationships between key variables associated with diagnostic competences (ie, diagnostic accuracy and evidence generation) in these assessment methods still require further research.
The aim of this
study is to compare perceived authenticity, cognitive load, and diagnostic competences in performance-based assessment using SPs and VPs. This
study also aims to examine the relationships of perceived authenticity, cognitive load, and quality of evidence generation with diagnostic accuracy.
We conducted an experimental
study with 86 medical students (mean 26.03 years, SD 4.71) focusing on history taking in dyspnea cases. Participants solved three cases with SPs and three cases with VPs in this repeated measures
study. After each case, students provided a diagnosis and rated perceived authenticity and cognitive load. The provided diagnosis was scored in terms of diagnostic accuracy; the questions asked by the medical students were rated with respect to their quality of evidence generation. In addition to regular null hypothesis testing, this
study used equivalence testing to investigate the absence of meaningful effects.
Perceived authenticity (1-tailed t81=11.12; P<.001) was higher for SPs than for VPs. The correlation between diagnostic accuracy and perceived authenticity was very small (r=0.05) and neither equivalent (P=.09) nor statistically significant (P=.32). Cognitive load was equivalent in both assessment methods (t82=2.81; P=.003). Intrinsic cognitive load (1-tailed r=-0.30; P=.003) and extraneous load (1-tailed r=-0.29; P=.003) correlated negatively with the combined score for diagnostic accuracy. The quality of evidence generation was positively related to diagnostic accuracy for VPs (1-tailed r=0.38; P<.001); this finding did not hold for SPs (1-tailed r=0.05; P=.32). Comparing both assessment methods with each other, diagnostic accuracy was higher for SPs than for VPs (2-tailed t85=2.49; P=.01).
The results on perceived authenticity demonstrate that learners experience SPs as more authentic than VPs. As higher amounts of intrinsic and extraneous cognitive loads are detrimental to performance, both types of cognitive load must be monitored and manipulated systematically in the assessment. Diagnostic accuracy was higher for SPs than for VPs, which could potentially negatively affect students\' grades with VPs. We identify and discuss possible reasons for this performance difference between both assessment methods.