关键词: 临床医学, 标准化病人, 原位模拟, 诊断学, 见习

Abstract: Objective To evaluate the effectiveness of in situ simulation (ISS) teaching involving standardized patients (SP) in the clerkship course of clinical diagnostics for medical students. Methods A self-controlled study was conducted. A total of 72 students from the five-year clinical medicine program (Excellent Physician Class, Grade 2021) who completed their clerkship training at the Affiliated Hospital of Southwest Medical University in the fall semester of 2024 were enrolled. The traditional clinical clerkship was used in the respiratory system and cardiovascular system probation, and the ISS teaching involving SP was used in the digestive system and nervous system probation. Students' subjective evaluations of the two teaching methods were collected via questionnaires, and their skill assessment scores were analyzed. Data were analyzed using McNemar's test and paired t-tests. Results In terms of learning effectiveness in history-taking, physical examination, and clinical reasoning ability, students reported high satisfaction rates with both traditional clinical clerkship and ISS teaching involving SP [98.6% (71/72) vs. 95.8% (69/72), 98.6% (71/72) vs. 97.2% (70/72), 94.4% (68/72) vs. 94.4% (68/72), all P>0.05]. Regarding psychological stress, 34 students (47.2%) experienced stress during traditional clinical clerkship, which was higher than the 14 students (19.4%) during ISS teaching involving SP (P<0.001). A total of 43 students (59.7%) preferred traditional clinical clerkship, citing the ability to encounter real patients earlier and to practice doctor-patient communication skills. In skill assessments, students achieved higher physical examination scores after ISS teaching involving SP than after traditional clinical clerkship [(85.16±3.37) vs. (80.92±3.74), P<0.001]. Conclusions Both teaching methods have their own strengths. Traditional clinical clerkship offers unique value in real patient contact and communication skill development, while ISS teaching involving SP may help reduce psychological stress and enhance physical examination skills. Combining the two methods may better meet the teaching requirements of the diagnostics clerkship course.

Key words: Clinical medicine, Standardized patients, In situ simulation, Diagnostics, Clinical practice