出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/07/02 13:16:55」(JST)
| This article may require cleanup to meet Wikipedia's quality standards. The specific problem is: WP:MOSBOLD. Please help improve this article if you can. (April 2014) |
In health care, a Simulated Patient, Standardized Patient, Sample Patient (aka SP's), and Patient Instructor is an individual trained to act as a real patient in order to simulate a set of symptoms or problems. Simulated Patients have been successfully used in the education and evaluation of nurses, nurse practitioners, physicians and surgeons, physician assistants or physician associates, and in basic, applied and translational medical research.
The Simulated Patient and Patient Instructor can also contribute to the development and improvement of healthcare protocols; especially in cases where input from the Simulated Patient and Patient Instructor are based on extensive, first-hand experience and observations as a clinical out-patient, or as a frequent in-patient.
Dr. Howard Barrows trained the first standardized patient in 1963 in University of Southern California. This SP simulated the history and examination findings of a paraplegic multiple sclerosis patient. Dr Barrows also developed a checklist that the SP could use to evaluate the performance of the trainee.[1] Dr. Paula Stillman trained another set of standardized patients in 1970 at the University of Arizona. Her pilot program had local actors portray the "mothers" of imaginary children. The actors would describe the illness the unseen child was suffering from, requiring the medical students taking the history to develop differential diagnoses based on the mother's testimony.[2] In 1984, a number of residency programs in the northeastern U.S. gave their residents the same examination using SPs. Medical Council of Canada was the first to use SPs in a licensure examination in 1993.[3] The Educational Commission for Foreign Medical Graduates introduced the Clinical Skills Assessment exam in 1998 to test the clinical skills of foreign medical graduates. This exam is now the USMLE Step 2 Clinical Skills exam and is mandatory for obtaining medical licensure in the United States, for both foreign medical graduates and American medical students.
Simulated patients are extensively used in medical and nursing education to allow students to practice and improve their clinical and conversational skills for an actual patient encounter. SPs commonly provide feedback after such encounters. They are also useful to train students to learn professional conduct in potentially embarrassing situations such as pelvic or breast exams. SPs are also used extensively in testing of clinical skills of students, usually as a part of an Objective Structured Clinical Examination. Typically, the SP will use a checklist to record the details of the encounter.
Simulated or Standardized patients, or Patient Instructors have also been sent unannounced into a physician practices to evaluate the standards of care. They are also employed as field researchers on health informatics projects. They can also assist in the development of seminars and lectures in an academic setting, under the supervision of full or associate professors.
The use of simulated patients has several advantages.[3][4]
At the same time, SPs are case specific and are able to assess clinical competency in a limited area only. Multiple encounters may be needed for broad ranged training or testing. Also, while SPs are quite proficient in simulating the symptoms, emotional states and even certain examination findings (neurological examination, for example), they may not be able to simulate certain other signs such as heart murmurs or lung sounds. Recruitment of SPs may also be difficult, time consuming and more expensive than using 'real' patients.[4]
Simulated patients are often recruited from the local amateur and professional acting community, through advertisements in local newspapers, or by word of mouth. Actual patients who take an active and self-taught role in their own healthcare may also be recruited. Graduate students in nearby universities may also agree to take up these roles. Patients and medical student working as a Simulated Patient or Patient Instructor can be paid upwards of $100/hour for their services.[5] SPs need to draw on their own personal experiences with physicians, conversations with healthcare professionals, talking to specific patient populations etc. They also need to be trained to accurately and reliably simulate particular clinical scenarios. Frequent quality assessment may be needed to ensure consistency in the portrayal of the patient role; especially since SPs may absorb a significant amount of clinical knowledge from their interactions with healthcare professionals.[5]
全文を閲覧するには購読必要です。 To read the full text you will need to subscribe.
| リンク元 | 「SP」「標準模擬患者」「模擬患者」 |
| 関連記事 | 「standardize」 |