背景:历史学习和临床推理是需要知识的重要技能,认知和元认知。重要的是,受训者必须经历与不同患者的多次接触才能练习这些技能。然而,患者安全也很重要,学员不得处理危重病人。为了解决这个问题,我们进行了一项随机对照试验,以确定在眼科研究生住院医师中使用虚拟患者(VP)和标准化患者(SP)来获得临床推理技能的有效性.
方法:来自拉合尔两家医院的研究生住院医师,巴基斯坦,被随机分配到VP组或SP组,并在预测试验后30分钟通过VP或SP进行临床推理练习。随后进行了后测。这个活动一个月后,进行了随访后测.使用IBM-SPSS版本25收集和分析数据。重复测量ANOVA用于跟踪学习技能随时间的影响。
结果:居民的平均年龄为28.5±3岁。男女比例为1:1.1。对于SP组,平均得分为12.6±3.08、16.39±3.01和15.39±2.95,VP组,预测试的平均得分分别为12.7±3.84,16.30±3.19和15.65±3.18,后测和后续后测,分别(p值<0.00)。然而,VP组和SP组之间的差异无统计学意义(p=0.896)。此外,在临床推理能力的保留方面,VP组和SP组之间没有统计学上的显着差异。在学习收获方面,与VP组相比,与VP组相比,SP组在临床推理锻炼后立即得分为51.46%,其中49.1%。一个月后,SP组为38.01,VP组为40.12%。
结论:VP可用于在安全的环境中学习研究生眼科住院医师的临床推理技能。这些设备可以重复使用,对真实患者没有任何风险。虽然同样有用,SP由于无法重复练习而受到限制。
BACKGROUND: History taking and clinical reasoning are important skills that require knowledge, cognition and meta-cognition. It is important that a trainee must experience multiple encounters with different patients to practice these skills. However, patient safety is also important, and trainees are not allowed to handle critically ill patients. To address this issue, a randomized controlled trial was conducted to determine the effectiveness of using Virtual Patients (VP) versus Standardized Patients (SP) in acquiring clinical reasoning skills in ophthalmology postgraduate residents.
METHODS: Postgraduate residents from two hospitals in Lahore, Pakistan, were randomized to either the VP group or the SP group and were exposed to clinical reasoning exercise via the VP or SP for 30 min after the pretest. This was followed by a posttest. One month after this activity, a follow-up posttest was conducted. The data were collected and analysed using IBM-SPSS version 25. Repeated measures ANOVA was used to track the effect of learning skills over time.
RESULTS: The mean age of the residents was 28.5 ± 3 years. The male to female ratio was 1:1.1. For the SP group, the mean scores were 12.6 ± 3.08, 16.39 ± 3.01 and 15.39 ± 2.95, and for the VP group, the mean scores were 12.7 ± 3.84, 16.30 ± 3.19 and 15.65 ± 3.18 for the pretest, posttest and follow-up posttest, respectively (p value < 0.00). However, the difference between the VP and SP groups was not statistically significant (p = 0.896). Moreover, there was no statistically significant difference between the VP and SP groups regarding the retention of clinical reasoning ability. In terms of learning gain, compared with the VP group, the SP group had a score of 51.46% immediately after clinical reasoning exercise as compared to VP group, in which it was 49.1%. After one month, it was 38.01 in SP and 40.12% in VP group.
CONCLUSIONS: VPs can be used for learning clinical reasoning skills in postgraduate ophthalmology residents in a safe environment. These devices can be used repeatedly without any risk to the real patient. Although similarly useful, SP is limited by its nonavailability for repeated exercises.