Assessment of Diagnostic Competences With Standardized Patients Versus Virtual Patients: Experimental Study in the Context of History Taking.
Assessment of Diagnostic Competences With Standardized Patients Versus Virtual Patients: Experimental Study in the Context of History Taking.
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DOI：
10.2196/21196
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发表时间：
2021-03-04
影响因子：
7.4
通讯作者：
Fischer MR
中科院分区：
文献类型：
--
作者：
Fink MC;Reitmeier V;Stadler M;Siebeck M;Fischer F;Fischer MR
标准化病人（SPs）是几十年来临床教学中流行的评估方法之一，尽管它需要大量的资源。如今，模拟虚拟患者（vp）的使用越来越多，因为它们是永久可用的，并且完全可扩展到大量受众。然而，比较这些评估方法的差异效果的实证研究缺乏。同样，这些评估方法中与诊断能力相关的关键变量（即诊断准确性和证据生成）之间的关系仍需要进一步研究。本研究的目的是比较在基于绩效的评估中使用sp和vp的感知真实性、认知负荷和诊断能力。本研究亦旨在探讨认知真实性、认知负荷和证据生成质量与诊断准确性的关系。我们对86名医学生（平均26.03岁，SD 4.71）进行了一项实验研究，重点研究了呼吸困难病例的病史。在这个重复测量研究中，参与者解决了三个SPs病例和三个VPs病例。在每个病例之后，学生提供诊断并评估感知真实性和认知负荷。根据诊断的准确性对所提供的诊断进行评分；对医学生提出的问题根据其证据生成的质量进行评分。除了常规的零假设检验外，本研究还使用等效检验来调查有无意义效应。感知真实性（单尾t81=11.12； P<.001）， sp高于vp。诊断准确性与感知真实性之间的相关性非常小（r=0.05），既不相等（P= 0.09），也没有统计学意义（P= 0.32）。两种评估方法的认知负荷相等（t82=2.81； P= 0.003）。内在认知负荷（单尾r= - 0.30； P= 0.003）和外在负荷（单尾r= - 0.29； P= 0.003）与诊断准确性的综合得分呈负相关。证据生成质量与VPs的诊断准确性呈正相关（单尾r=0.38； P< 0.001）；这一发现并不适用于SPs（单侧r=0.05； P= 0.32）。两种评估方法相互比较，SPs的诊断准确率高于VPs（双尾t85=2.49； P= 0.01）。感知真实性的结果表明，学习者对sp的体验比副总裁更真实。由于大量的内在和外在认知负荷对表现有害，因此在评估中必须系统地监测和操纵这两种类型的认知负荷。sp的诊断准确性高于vp，这可能会对vp学生的成绩产生潜在的负面影响。我们确定并讨论了两种评估方法之间性能差异的可能原因。
Standardized patients (SPs) have been one of the popular assessment methods in clinical teaching for decades, although they are resource intensive. Nowadays, simulated virtual patients (VPs) are increasingly used because they are permanently available and fully scalable to a large audience. However, empirical studies comparing the differential effects of these assessment methods are lacking. Similarly, the relationships between key variables associated with diagnostic competences (ie, diagnostic accuracy and evidence generation) in these assessment methods still require further research. The aim of this study is to compare perceived authenticity, cognitive load, and diagnostic competences in performance-based assessment using SPs and VPs. This study also aims to examine the relationships of perceived authenticity, cognitive load, and quality of evidence generation with diagnostic accuracy. We conducted an experimental study with 86 medical students (mean 26.03 years, SD 4.71) focusing on history taking in dyspnea cases. Participants solved three cases with SPs and three cases with VPs in this repeated measures study. After each case, students provided a diagnosis and rated perceived authenticity and cognitive load. The provided diagnosis was scored in terms of diagnostic accuracy; the questions asked by the medical students were rated with respect to their quality of evidence generation. In addition to regular null hypothesis testing, this study used equivalence testing to investigate the absence of meaningful effects. Perceived authenticity (1-tailed t81=11.12; P<.001) was higher for SPs than for VPs. The correlation between diagnostic accuracy and perceived authenticity was very small (r=0.05) and neither equivalent (P=.09) nor statistically significant (P=.32). Cognitive load was equivalent in both assessment methods (t82=2.81; P=.003). Intrinsic cognitive load (1-tailed r=−0.30; P=.003) and extraneous load (1-tailed r=−0.29; P=.003) correlated negatively with the combined score for diagnostic accuracy. The quality of evidence generation was positively related to diagnostic accuracy for VPs (1-tailed r=0.38; P<.001); this finding did not hold for SPs (1-tailed r=0.05; P=.32). Comparing both assessment methods with each other, diagnostic accuracy was higher for SPs than for VPs (2-tailed t85=2.49; P=.01). The results on perceived authenticity demonstrate that learners experience SPs as more authentic than VPs. As higher amounts of intrinsic and extraneous cognitive loads are detrimental to performance, both types of cognitive load must be monitored and manipulated systematically in the assessment. Diagnostic accuracy was higher for SPs than for VPs, which could potentially negatively affect students’ grades with VPs. We identify and discuss possible reasons for this performance difference between both assessment methods.
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DOI：
10.1186/s41077-017-0043-4
发表时间：
2017
期刊：
Advances in simulation (London, England)
影响因子：
--
作者：
Lewis KL;Bohnert CA;Gammon WL;Hölzer H;Lyman L;Smith C;Thompson TM;Wallace A;Gliva-McConvey G
通讯作者：
Gliva-McConvey G
影响因子：
4.2
作者：
Lapkin, Samuel;Levett-Jones, Tracy
通讯作者：
Levett-Jones, Tracy
DOI：
10.1177/2515245918770963
发表时间：
2018-06-01
影响因子：
13.6
作者：
Lakens, Daniel;Scheel, Anne M.;Isager, Peder M.
通讯作者：
Isager, Peder M.
影响因子：
6
作者：
Hawkins, R;Gaglione, MM;Ciccone, A
通讯作者：
Ciccone, A
影响因子：
--
作者：
HARDEN, RM;STEVENSON, M;WILSON, GM
通讯作者：
WILSON, GM