@Article{info:doi/10.2196/21196，作者=“Fink, Maximilian C and Reitmeier, Victoria and Stadler, Matthias and Siebeck, Matthias and Fischer, Frank and Fischer, Martin R”，标题=“标准化患者与虚拟患者的诊断能力评估:历史采集背景下的实验研究”，期刊=“J Med Internet Res”，年=“2021”，月=“Mar”，日=“4”，卷=“23”，号=“3”，页=“e21196”，关键词=“临床推理”;医学教育;绩效评估;模拟;标准化病人;背景:标准化患者(SPs)是近几十年来临床教学中较为流行的评估方法之一，但它需要大量的资源。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。目的: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。 This study also aims to examine the relationships of perceived authenticity, cognitive load, and quality of evidence generation with diagnostic accuracy. Methods: 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. Results: 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). Conclusions: 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. ", issn="1438-8871", doi="10.2196/21196", url="//www.mybigtv.com/2021/3/e21196", url="https://doi.org/10.2196/21196", url="http://www.ncbi.nlm.nih.gov/pubmed/33661122" }