Development of clinical curriculum with simulated patients and objective assessment method

(1)模拟病人（SP）课程开发。在日本，医疗面谈培训仅限于在诊所首次见到有简单症状的病人。我们在各种临床情况下为患者制定了场景，包括“解释实验室和检查数据并诱导患者自主”、“患者教育”和“告知坏消息”。我们创造了SP和医生的场景。我们在医学院的课程和师资发展中实施了SP培训和有效的学习计划，其中包括与SP在小组中进行讲座和角色扮演的实践。制作SP评估表，评估患者在不同临床环境下的沟通能力。(2)欧安组织SP对医疗面谈的评价。普通国家欧安组织对临床前医科学生不要求SP等级。在日本，标普的角色只是“玩家”，而不是评级者。我们建立了欧安组织医学访谈的SP评分表，并通过分析Cronbach alpha、与标准评估的一致性（通过视频检查）、peon相关性与教师评估进行比较。SP评估结果与教师的可信度高，与标准评分的一致性高，在信息收集、面试框架和沟通技巧方面与教师评分的相关性显著。与教师沟通能力的相关性较低，说明SP评分表达的是患者的观点，应该与教师评分有所不同。SP等级作为学习者评估有价值。我们的结果表明，SP评级是可靠的，可以作为评级机构在欧安组织包括高风险考试。我们的研究是第一个在日本证明SP评级的信度和效度的报告。

(1)Development of curriculum with simulated patients (SP).In Japan, medical interview training is limited to the situation of first visit patient with simple symptom at a clinic. We developed patients' scenarios at variety of clinical situations including ‘explain the lab and exam data and induce patients autonomy', ‘patient education', and ‘break bad news'. We created scenario with SP and medical doctors. SP training and effective learning program with lecture and practice by role play with SPs at small group was implemented to our 4^<th> year medical school curriculum and faculty development. Assessment sheet by SP, which could assess the communication skills at various clinical settings was also created.(2)Evaluation of medical interview by SP at OSCE.SP rating is not required at Common National OSCE for preclinical medical students. Role of SP was only ‘player' but not raters in Japan. We set up SP rating sheet for medical interview at OSCE, and compare with faculty's assessment by analyzing Cronbach alpha, consistency with standard assessment (checked by video), Peason Correlation. SP assessment showed high reliability as faculty, high consistency with standard rating, significant correlation with faculty rating for areas of information gathering, interview framework, and communication skills. Relatively low correlation with faculty in communication skills indicates that SP rating expresses patient's standpoint and it should be different from faculty rating. SP rating has value using as learner's assessment. Our results indicate that SP rating is reliable and could be used as raters at OSCE including high stakes examinations. Our research is the first report to show the evidence of reliability and validity of SP rating in Japan.