The use of clinical simulations in assessment
The use of clinical simulations in assessment
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DOI：
10.1046/j.1365-2923.37.s1.8.x
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发表时间：
2003-11-01
影响因子：
6
通讯作者：
van der Vleuten, CPM
中科院分区：
文献类型：
--
作者：
Schuwirth, LWT;van der Vleuten, CPM
基于情景模拟的测试方法已经被开发出来，以满足对既真实又结构良好的评估程序的需求。人们普遍认为，尽管程序的真实性可能是其有效性的一个贡献因素，但仅有真实性永远不是充分的因素。目的描述各种基于模拟的方法的主流发展，以及它们的优缺点。其目的不是在广泛的荟萃分析的基础上提供综述，而是提出这些方法发展中的关键因素及其对当前和未来发展的影响。方法根据米勒金字塔的层次对这些基于模拟的工具进行细分。书面和基于计算机的模拟旨在衡量“知道如何”层，基于观察的技术，如标准化的基于患者的检查和客观结构化的临床检查，目标是“展示”层和绩效实践衡量标准，以评估“做”层的表现。结论在所有模拟中，病例特异性被发现对可靠性构成最突出的威胁，而太多的结构可能会使评估变得平淡无奇。结论是，真实和可靠的评估是建立在效率和充分的内容抽样之间的明智平衡的基础上的。
Context Simulation-based testing methods have been developed to meet the need for assessment procedures that are both authentic and well-structured. It is widely acknowledged that, although the authenticity of a procedure may be a contributing factor to its validity, authenticity alone never is a sufficient factor.Aim In this paper we describe the mainstream development of various simulation-based approaches, with their strengths and weaknesses. The purpose is not to provide a review based on an extensive meta-analysis but to present crucial factors in the development of these methods and their implications for current and future developments.Method The description of these simulation-based instruments uses a subdivision according to the layers of Miller's pyramid. Written and computer-based simulations are aimed at measuring the 'knows how' layer, observation-based techniques such as standardised patient-based examinations and objective structured clinical examinations target the 'shows how' layer and performance practice measures assess performance at the 'does' layer.Conclusion In all simulations, case specificity was found to pose the most prominent threat to reliability, while too much structure threatened to trivialise the assessment. The conclusion is that authentic and reliable assessment is predicated on a wise balance between efficiency and adequate content sampling.