표준화학생(simulated student)를 활용한 표준화환자(standardized patient) 평가

(출처 : http://www.daveswhiteboard.com/archives/4398)

Barrows와 Abrahamson은 이미 1960년대부터 SP를 임상교육과 평가에 활용할 것을 제안했다. SP는 특정 환자의 사례를 묘사하는 동시에 학생의 수행능력을 정확하고 일관되게 평가하도록 훈련된 비의사(non-physician)연기자이다.

Barrows and Abrahamson (1964) proposed the standardized patient (SP) in the early 1960s as a tool for clinical skill instruction and assessment. The SP is a non-physician who has been trained not only to portray a specific patient case but also to accurately and consistently record student performance. 

SP의 활용은 지난 십년간 계속 증가하여, 최근의 보고를 보면 미국 의과대학의 75%가 SP를 술기 평가에 활용하고 있으며, 63%는 OSCE나 CPX시험에 활용하고 있다.

The use of SPs has increased, particularly over the past decade. A recent annual survey reported that 75% of U.S. medical schools are using SPs for evaluations in introductory skills courses, and 63% are using SPs in an objective structured clinical examination or the clinical performance examination (CPX) (Barzansky & Etzel 2003). 

SP가 일관되게 연기를 하고 평가를 하는 것은 굉장히 중요하다. 여기서는 반복적으로 일관되게 응시자의 역할을 하도록 훈련된 모의학생(simulated student)을 활용하여 서로 다른 SP들의 신뢰도(reliability)를 평가하고자 하였다.

The consistency of SP performance and rating is very important in SP assessments, particularly when several SPs have been trained to simulate a given case. We designed the concept of ‘simulated students’ who repeatedly and consistently performed the role of examinee to evaluate the utility of simulated students as a means to check the reliability of the rating of different SPs in a CPX.

Result

학생간 차이가 가장 큰 열 쌍의 SP-학생 pair에서 중앙값은 30점(26~38)이었으며,

같은 SP-학생 pair를 교수가 평가한 점수는 중앙값이 3점(0~7)이었다.

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Med Teach. 2007 Nov;29(9):978-80.

Evaluation using simulated students for reliability of multiple standardized-patients scoring in clinical performance examinations.

Park WB, Lee SA, Kim EA, Gwack J, Yoo KY, Shin JS, Lee YS.

Source

Office of Medical Education, Seoul National University College of Medicine, Republic of Korea.

Abstract

BACKGROUND:

The consistency of rating among different standardized patients (SPs) is very important in clinical performance examinations (CPX). Aims: We evaluated the usefulness of simulated students to assess the reliability of a group of standardized patients in a CPX.

METHODS:

Five SPs in each case were trained to simulate the same patient in a CPX. Ten fourth-year medical student volunteers were selected to act as simulated students. After the simulated students encountered the first SP, they reviewed a video of their performance and sequentially repeated the performance with the other 4 SPs.

RESULTS:

The average maximum difference (Deltamax +/- SD) of multiple SPs' percent scores on a simulated student was 18 +/- 7. In 10 pairs of SPs who gave largest Deltamax on a given student, the median Deltamax was 30 (range, 26-38) while median difference of percent score in the faculty scoring on the same simulated student was 3 (range, 0-7). Five problematic SPs whose ratings were significantly different from 3 or more other SPs' ratings in each case were identified.

CONCLUSIONS:

Simulated students may be a useful means to check the consistency of rating among different SPs in a CPX.