目的 探讨标准化病人(standardized patients,SP)参与的原位模拟(in situ simulation,ISS)教学在临床医学专业诊断学见习课程中的应用效果。方法 采用自身对照研究方法。以2024年秋季学期于西南医科大学附属医院进行见习的2021级五年制临床医学专业卓越医师班72名学生为研究对象。在呼吸系统和心血管系统见习中采用传统临床见习教学方式,在消化系统和神经系统见习中采用SP参与的ISS见习教学方式。以问卷调查形式收集学生对2种教学方式的评价,同时分析学生技能考核成绩。采用McNemar检验和配对t检验等方法分析数据。结果 在问诊学习效果、体格检查学习效果和临床思维能力培养3个方面,学生对传统临床见习与SP参与的ISS见习2种教学方式的满意率均较高[98.6%(71/72)比95.8%(69/72)、98.6%(71/72)比97.2%(70/72)、94.4%(68/72)比94.4%(68/72)],其差异均无统计学意义(均P>0.05)。心理压力方面,传统临床见习中34名(47.2%)学生存在压力,高于SP参与的ISS见习的14名(19.4%)学生,其差异具有统计学意义(P<0.001)。43名(59.7%)学生更倾向于传统临床见习,认为该教学方式能够更早接触真实患者和训练医患沟通能力。技能考核方面,SP参与的ISS见习时学生的体格检查成绩高于传统临床见习时的成绩[(85.16±3.37)分比(80.92±3.74)分],其差异具有统计学意义(P<0.001)。结论 2种教学方式各具优势,传统临床见习在真实患者接触和沟通能力培养上具有独特价值,而SP参与的ISS见习可能有助于降低学生见习心理压力、提升体格检查技能。二者结合使用可能更有利于满足诊断学见习课程的教学需求。
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.
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