외래 세팅(ambulatory care settings)에서 표준화환자(standardized patients)를 활용한 의학교육

(출처 : http://www.temple.edu/ics/about/standardized.html)

지난 십년간 의료에 있어 가장 변화는 입원(inpatient) 중심에서 외래(ambulatory care) 중심으로 옮겨갔다는 것이다. 입원환자는 질병의 중증도가 더 심하고 특정 분과에 관련된 사례를 대표하는 경우가 많아 학생 교육에 있어서도 적절하지 않은 측면이 있다. 또한 환자들도 좀 더 외래 중심으로 진료를 받고 싶어한다. 

One of the most dramatic changes in healthcare during the past decade has been the shift of care from the inpatient to the ambulatory care setting. The changes in healthcare delivery mean that the inpatient setting is less than ideal for teaching undergraduate students (Irby 1995; Levinsky 1998). Since inpatients tend to be more representative of subspecialty conditions or be more critically ill, they become less representative of routine medical practice. Patients in hospital are more likely to be under acute active management than convalescing. As contemporary practice and patient expectations are in favor of a shorter hospital stay, more patients with common conditions are being treated as outpatients than as inpatients. These changes place the emphasis of clinical teaching on ambulatory care rather than the traditional inpatient setting (Fincher et al. 1997; Cardarelli & Sanders 2005; Dent 2005).

학부의학교육에서 환자와의 상호작용을 가르치는 것은 매우 중요하다. 그러기 위해서는 교육에 도움을 줄 환자가 필요한데, 가장 적합한 환자를 선택하는 것은 어려움이 많다.

Patient interactions have always been an integral part of undergraduate medical education. Patient interactions help students build integrated skills for history taking and communication, physical examinations, and clinical reasoning (Dammers et al. 2001; Littlewood et al. 2005; Dornan et al. 2006) However, to maximize educational efficiency, appropriate patient selection is essential. As described in a previous qualitative study, several key factors, such as, educational value, the doctor-patient relationship, and time efficiency should be considered to find ‘‘the best’’ patients for medical teaching (Simon et al. 2003). However, despite the importance of appropriate patient selection, this can be a difficult and time-consuming process in the ambulatory care setting. 

표준화환자를 활용할 경우 여러 이점이 많다. 표준화환자를 활용하여 외래 상황을 시뮬레이션하는 방식으로의 교육을 디자인하고 시도해보았다.

Barrows described several advantages of using standardized patients (SPs) as compared with real patients, including their availability, flexibility, and standardization (Barrows 1993). Other studies demonstrated that students regarded the standardization of the learning experience, a safe learning environment and the feedback offered by SP as important advantages (Bokken et al. 2008, 2009). Given that increasing proportion of care is delivered in ambulatory settings and access to real patients with educational value are limited, we describe the design, implementation, and evaluation of a simulated outpatient clinic using SPs.

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Med Teach. 2010;32(11):e467-70. doi: 10.3109/0142159X.2010.507713.

The use of standardized patients to teach medical students clinical skills in ambulatory care settings.

Myung SJ, Kang SH, Kim YS, Lee EB, Shin JS, Shin HY, Park WB.

Source

Seoul National University College of Medicine, Republic of Korea.

Abstract

BACKGROUND:

Ambulatory medicine is being increasingly emphasized in undergraduate medical education. Because of the limited availability of real patients, we introduced a standardized patient (SP) encounter program in an ambulatory care setting.

AIMS:

This study was undertaken to assess the usefulness of SPs for teaching undergraduate students clinical skills in ambulatory settings.

METHOD:

Third-year medical students met two different SPs, who presented common authentic problems, during internal medicine clerkship. Each SP encounter of 30 min was followed by SP and a tutor's feedback, using a video recording of the SP encounter. We surveyed students for program evaluation purposes at the end of their three-year internal medicine clerkships (from 2006 to 2008).

RESULTS:

Most students found that the consecutive SP sessions were instructive and helpful. Video recordings of clinical encounters allowedstudents to reflect on their behavior and receive feedback from tutors. However, students identified several weaknesses of these SP encounters. For example, pre-exposure to the SP scenario reduced tension of the experience and inconsistent feedback from tutors caused confusion.

CONCLUSIONS:

SP encounters in an ambulatory care setting, followed by tutor's feedback based on a video recording, can be used for teachingbasic clinical ambulatory care skills.