标准化患者教学模式提高住院医师规范化培训效果的Meta分析

Effects of standardized patients teaching model on standardized residency training: a meta-analysis

采用Meta分析,检验标准化患者教学模式(Standardized Patient Teaching Model,SPTM)是否有助于提高住院医师的理论知识和病例分析能力。采用文献检索,以住院医师规范化培训、标准化患者等为关键词制定相应的检索策略,在中国知网(CNKI)、万方数据知识服务平台、维普网等常用中文数据库,检索从2014年1月~2017年9月所有国内已发表的标准化患者与住院医师规范化培训的相关文献。文献资料提取和方法学质量评价:严格按照制定的纳入排除标准筛选文献,所有资料由2名评价员独立进行文献资料提取,如有分歧,则通过讨论或由第3位研究者协助解决。文献质量评价采用Cochrane手册中推荐的偏倚风险评价工具,Meta分析采用Rev Man 5.3软件,证据质量分级采用GRADEpro 3.6软件。结果:文献检索共检索出578篇文献,经过反复筛选后最终纳入4篇,均为临床随机对照研究。Meta分析:SPTM与传统教学模式相比较,在提高理论知识方面[SMD=0.39,95%CI(0.14,0.65),P<0.05];异质性检验无统计学意义,I^2=0%;证据质量GRADE分级为极低。而在提高病例分析能力方面[SMD=2.13,95%CI(1.21,2.83),P<0.05)];异质性检验具有统计学意义,I^2>75%;证据质量GRADE分级为极低。通过上述结果可知:SPTM可显著提高住院医师的理论知识水平,但对提高住院医师的病例分析能力的作用尚不明确。

This article examined whether standardized patients teaching model(SPTM)helps to improve the theoretical knowledge and case analysis abilities of residents in training by meta-analysis.Literatures on standardized patients and standardized residency training in Chinese,published between January 2014 and September 2017,were searched systematically in CNKI(China National Knowledge Infrastructure),Wanfang database,VIP database.The key words included“standardized residency training”and“standardized patient”.The studies were strictly selected according to the inclusion and exclusion criteria by two authors independently.Disagreements were resolved by the third party.The qualities of each included study were evaluated according to the recommendation of the Cochrane Collaboration.Meta analyses was performed on Review Manager(RevMan)(version 5.3).In addition,the qualities of evidences were evaluated by GRADE profile 3.6 software.Results:A total of 578 articles were retrieved,but only 4 were included,which were randomized clinical trials.Meta-analysis showed standardized patients teaching method was superior to traditional methods in terms of improving theoretical knowledge[SMD=0.39,95%CI(0.14,0.65),P<0.05];this result had no heterogeneity,I2=0%;GRADE rating quality of evidence is extremely low.Standardized patients teaching method was superior to traditional methods in the case analysis[SMD=2.13,95%CI(1.21,2.83),P<0.05];however this result had heterogeneity,I2>75%;GRADE rating quality of evidence is extremely low.It comes to a conclusion that standardized patients teaching method is associated with better theoretical knowledge learning effects among residents compared with that of the traditional methods,but there is no such clear association between SPTM and case analysis abilities of the residents.