Standardized Patients’ Quality Of Medical Humanistic Quality Assessment In OSCEs

Objective:(1)To summarize the research status of Standardized patients(SPs)in assessing medical students’ humanistic quality in Objective structured clinical examinations(OSCEs),through reviewing literatures and articles about the concepts and theories of SPs,OSCEs,humanities and so on;(2)To analyze SPs’ assessment quality of medical students’ humanistic quality and which factors affect the quality of assessment in the basis of quantitative study;(3)By qualitative research such as interviews,analyze the problems and causes of SPs in assessing medical humanistic quality;(4)Combining with literature and practical results to carry on SWOT analysis on SPs’ assessment quality of medical humanistic quality.Provide strategies and suggestions for improving SPs’ assessment quality.Materials and Methods: There are 24 standardized patients and 297 clinical medical students in grade 2014 participating in the 2018 National Clinical Physician Qualifications Phased Examination(hereinafter referred to as the Phased Examination).The students participating in the OSCES include 173 long-term students and 124 five-year students.The main research methods are as followed:(1)Literature research: The research status of SPs’ assessment about medical humanistic quality in OSCEs was summarized by the analysis of relevant literature resources.(2)Empirical research: Conducting an empirical study to collect and analyze SPs’ assessing data of medical students’ humanities quality in the first and second stations of OSCEs.At the same time,the medical examiners’ humanistic quality scores and the humanistic knowledge scores of the student’s theoretical test were used as control groups.(3)Focus group interview: A focus group was set up to conduct a semi-structured interview around the theme of SPs’ role orientation when assessing,bad psychological effects in assessment,important factors of competing assessment job,the influence of OSCEs work intensity on SPs assessment and other suggestions.(4)Statistical analysis: The measurement data was described by mean,standard deviation,median and interquartile range,and the categorical data is described by ratio.Spearman correlation was used to test correlation between SPs scores and theoretical scores,medical examiners’ scores.Multiple independent samples Kruskal-Wallis one-way ANOVA method was used to test the differences in scores of different sub-items and SPs scores of different academic systems,classes,test cases and test sessions.Multivariate regression analysis was used to test influencing factors of SPs scores.Result: According to the total scores of SPs,the number of medical students who reached the level of acceptable quality in the first and second stations(gaining 12 points or more)accounted for 99.33% and 96.97% respectively.The discrimination between two stations was good,with 0.31 and 0.43 respectively.SPs gave lower scores on “Humanistic Care” than other sub-items.SPs’ scores were highly credible and had a strong correlation with medical examiners’ scores.The correlation coefficient was 0.763.However,SPs’ scores had a weak correlation with medical students’ scores of humanistic knowledge and theory(p<0.05),and the correlation coefficient was 0.184.SPs scores showed good consistency,because there was no difference in SPs scores among different test sessions(p>0.05).In the analysis of various factors affecting the quality of SPs evaluation,it shows that single factor has no effect on SPs score,but the combined factors of gender and age have an impact on SPs’ score.Female elderly tends to give a higher score.It shows that SPs could adapt to the continuous 3~4 hours work in OSCEs,sufficient pre-test training and unification of scoring standards are objective conditions to assure SPs’ assessment quality,and that SPs cognitive impairment in assessment and “halo effect” are subjective affecting factors of SPs’ assessment quality in the semi-structured interview.Conclusion: The advantages of SPs method in evaluating medical humanistic quality are as follows:(1)the assessment from the perspective of patients is more visual;(2)the assessment from SPs in OSCEs is reliable(r=0.763),distinctively(D=0.31/0.43)and consistent(p>0.05);(3)the effective feedback provided by SPs benefits students.However,the limitations of SPs method for the assessment of humanistic quality are as follows:(1)the scope of SPs for the assessment of humanistic quality is limited;(2)SPs lack a clear understanding of their role as an examiner;(3)the standard of evaluation is disturbed by psychological effects of SPs;(4)the degree of stringency of the assessment is inconsistent.Therefore,On the basis of learning from foreign experience about the monitoring of the quality of SPs assessment,this paper(1)improved the quality monitoring of SPs project,verified whether different SP could make the same evaluation score for the same student′s performance and constructed SPs competency model;(2)analyzed the reasons for the problems of abnormal scoring,carried out intensive training and adjusted the task;(3)The evaluation scale was further refined and interpreted,Adjust and construct appropriate evaluation scale when is necessary.Finally,the future direction to monitor and improve SPs′s quality is the further establishment of SPs′s evaluation competency model.