随着计算机技术的不断发展和模拟技术的进步,计算机模拟病例开始在医学教育领域获得广泛应用,对医学生临床能力的教育和评价发挥着越来越重要的作用。美国医学考试委员会对计算机模拟病例考试的信度、效度、评分方法、影响因素以及考生的操作行为进行了大量研究,1999年开始正式将计算机模拟病例应用于美国国家执业医师资格考试中。近年来,美国部分高校开始研究开发与计算机模拟病例相关的软件,对医学生临床能力进行教育教学和评价。
With the development of computer technology and simulative technology, computer-based case simulations (CCS) are widely used in medical education, which plays a more and more important role in the evaluation and education of medical students' clinical competency. American National Board of Medical Examiners has done a lot of work to test the reliability and validity of CCS, scoring method, influencing factors, and the operational behavior of examinees. In 1999 , computer-based case simulations formally began to apply in the United States Medical Licensing Examination (USMLE).In recent years, some colleges and universities in the United States have begun to research and develop operating systems similar to that of CCS, used for teaching and evaluation on the clinical competence of medical students.
[1] Scheuneman JD, Van Fan Y, Clyman SG.An investigation of the difficulty of computer-based case simulations[J]. Med Educ,1998,32(2):150-158.
[2] Dillon GF, Clyman SG, Clauser BE, et al.The introduction of computer-based case simulations into the United States medical licensing examination[J]. Acad Med, 2002,77(10 Suppl):S94-S96.
[3] Dillon GF, Clauser BE.Computer-delivered patient simulations in the United States Medical Licensing Examination (USMLE)[J]. Simul Healthc, 2009,4(1):30-34. DOI:10.097/SIH.0b013e3181880484.
[4] Clauser BE, Margolis MJ, Swanson DB.An examination of the contribution of computer-based case simulations to the USMLE step 3 examination[J]. Acad Med, 2002,77(10 Suppl):S80-S82.
[5] Margolis MJ, Clauser BE, Harik P, et al.Examining subgroup differences on the computer-based case-simulation component of USMLE step 3[J]. Acad Med, 2002,77(10 Suppl):S83-S85.
[6] Lynch TG, Zadalis RJ, Schneider PD.Repeated use of computerized case simulations in a test format does not present a security risk[J]. Am J Surg, 1999,177(3):270-273.
[7] Lynch TG, Schneider PD.Availability of content information does not improve performance on computerized case simulations[J]. Am J Surg, 2000,179(6):472-475.
[8] Margolis MJ, Clauser BE, Harik P.Scoring the computer-based case simulation component of USMLE step 3: A comparison of preoperational and operational data[J]. Acad Med, 2004,79(10 Suppl):S62-S64.
[9] Feinberg RA, Swygert KA, Haist SA, et al.The impact of postgraduate training on USMLE ® step 3 ® and its computer-based case simulation component[J]. J Gen Intern Med, 2012,27(1):65-70. DOI: 10.1007/s11606-011-1835-1.
[10] Floreck LM, Guernsey MJ, Clyman SG, et al.Examinee performance on computer-based case simulations as part of the USMLE step 3 examination: Are examinees ordering dangerous actions[J]? Acad Med, 2002,77(10 Suppl):S77-S79.
[11] Harik P, Cuddy MM, O'Donovan S, et al.Assessing potentially dangerous medical actions with the computer-based case simulation portion of the USMLE step 3 examination[J]. Acad Med, 2009,84(10 Suppl):S79-S82. DOI:10.1097/ACM.0b013e3181b379bc.
[12] Sample L, Laduca T, Leung C, et al.Comparing patient-management skills of referred physicians and non-referred physicians on a computer-based case-simulation examination[J]. Acad Med, 2001,76(10 Suppl):S24-S26.
[13] Schauer GF, Robinson DJ, Patel VL.Right diagnosis, wrong care: Patient management reasoning errors in emergency care computer-based case simulations[J]. AMIA Annu Symp Proc, 2011:1224-1232.
[14] Feldman MJ, Barnett GO, Link DA, et al.Evaluation of the clinical assessment project: A computer-based multimedia tool to assess problem-solving ability in medical students[J]. Pediatrics, 2006,118(4):1380-1387. DOI:10.1542/peds.2006-0326.
[15] Kreiter CD, Haugen T, Leaven T, et al.A report on the piloting of a novel computer-based medical case simulation for teaching and formative assessment of diagnostic laboratory testing[J]. Med Educ Online, 2011,16. DOI:10.3402/meo.v16i0.5646.
[16] Dong T, Kelly W, Hays M, et al.An investigation of professionalism reflected by student comments on formative virtual patient encounters[J]. BMC Med Educ,2017,17(1):3.