虚拟病人在全科住培教学中的应用发展与展望

马云笛; 任菁菁; 邱艳

doi:10.16766/j.cnki.issn.1674-4152.004265

虚拟病人在全科住培教学中的应用发展与展望

doi: 10.16766/j.cnki.issn.1674-4152.004265

马云笛^{1, 2},
任菁菁^2, ,,
邱艳²

1.
浙江大学医学院，浙江杭州 310029
2.
浙江大学医学院附属第一医院全科医学科，浙江杭州 310003

基金项目:

国家自然科学基金项目 72274169

详细信息

通讯作者:
任菁菁，E-mail：3204092@zju.edu.cn

中图分类号: R192 R499
计量
- 文章访问数: 3
- HTML全文浏览量: 3
- PDF下载量: 0
- 被引次数: 0
出版历程
- 收稿日期: 2025-02-10
- 网络出版日期: 2026-01-07

Application and prospect of virtual patient in general practice residency training

MA Yundi^{1, 2},
REN Jingjing^{2
, ,},
QIU Yan²

1.
School of Medicine, Zhejiang University, Hangzhou, Zhejiang 310029, China

摘要

摘要: 全科医师(GPs)作为我国居民健康的“守门人”，承担着常见病、慢性病以及未分化疾病等诊疗工作，同时还需负责传染病防控、健康管理等基本公共卫生服务。全科医师的培养对于提升医疗服务水平和保障居民健康具有重要意义，而全科住院医师规范化培训则是其教育体系中的关键环节，直接关系到全科医师的专业素养和服务能力。然而，当前全科住院医师规范化培训仍面临诸多挑战，如培养模式较为单一、师资力量不足、住院医师实际接触的患者和病种数量有限等。随着人工智能技术的发展，虚拟病人逐渐成为住院医师培养领域的重要工具。虚拟病人能够为住院医师提供安全、灵活且可重复的学习环境，并提供及时、针对性的反馈以及个性化和丰富的学习内容。尽管如此，虚拟病人的应用与发展也面临一些挑战，包括技术与设备的可及性不足、临床实践中的情境差异，以及伦理和隐私问题等。本研究通过系统检索相关文献，深入探讨全科住院医师规范化培训的现状，分析虚拟病人在住院医师教育中的应用现状、优势与挑战，并展望其在全科医师培养中的发展前景。本研究期望为我国全科医师培养模式的优化提供理论依据和实践参考，为全科医学教育的改革与发展提供有益建议，并助力我国全科医师培养体系的完善。
- 虚拟病人 /
- 全科医学 /
- 住院医师规范化培训 /
- 发展 /
- 展望
Abstract: General practitioners (GPs) function as the primary healthcare providers for the nation' s population, responsible for the diagnosis and treatment of a wide range of medical conditions, including both common and complex diseases. Furthermore, they are entrusted with the provision of fundamental public health services, encompassing the prevention and control of infectious diseases, as well as health management. The standardized residency training is a pivotal component of GP education, exerting a direct influence on the professional competence and service capacity of GPs. Nevertheless, the prevailing training paradigm confronts numerous challenges, including a constrained training approach, inadequate faculty, and limited exposure to a diverse array of patients and disease manifestations. The advent of artificial intelligence has led to the emergence of virtual patients as a significant instrument in the education of resident physicians. These institutions offer a secure, adaptable and consistent learning environment for residents, in addition to prompt and relevant feedback. They provide customized and comprehensive learning materials. However, the application and development of virtual patients also face challenges, such as inadequate accessibility of technology and equipment, differences in clinical practice scenarios, and ethical and privacy issues. The objective of this study is to systematically review the extant literature on the subject in order to make an informed assessment of the current status of standardized training for general practice residents. In addition, the study will analyze the application status, advantages and challenges of virtual patients in resident education. Finally, this study will look forward to their future development prospects in the training of general practitioners. This study is expected to provide a theoretical basis and practical references for optimizing the GP training model in China, offer beneficial suggestions for the reform and development of general practice education, and contribute to the improvement of the GP training system.
- Virtual patients /
- General practice /
- Standardized residency training /
- Development /
- Prospect

HTML全文

参考文献(40)

[1]	齐殿君. 中国全科医学住院医师置信职业行为评价框架的构建与初步应用[D]. 沈阳: 中国医科大学, 2022. QI D J. Construction and preliminary application of the evaluation framework of professional behavior of Chinese general practice resident physicians[D]. Shenyang: China Medical University, 2022.
[2]	陈国湘, 李俊, 韦华, 等. 基于人工智能技术的全科医生培养模式探索[J]. 中华全科医学, 2021, 19(2): 167-170. doi: 10.16766/j.cnki.issn.1674-4152.001758 CHEN G X, LI J, WEI H, et al. Exploration of general practitioner training model based on artificial intelligence technology[J]. Chinese Journal of General Practice, 2021, 19(2): 167-170. doi: 10.16766/j.cnki.issn.1674-4152.001758
[3]	王娜, 何晓琴, 金松, 等. 基于虚拟病人的住院医师临床思维培训工作坊的设计与实践[J]. 中国毕业后医学教育, 2024, 8(6): 469-472. WANG N, HE X Q, JIN S, et al. Design and application of a clinical reasoning training workshop with virtual patients for resident physicians[J]. Chinese Journal of Graduate Medical Education, 2024, 8(6): 469-472.
[4]	MALIK T G, MAHBOOB U, KHAN R A, et al. Virtual patients versus standardized patients for improving clinical reasoning skills in ophthalmology residents. A randomized controlled trial[J]. BMC Med Educ, 2024, 24(1): 429. DOI: 10.1186/s12909-024-05241-4.
[5]	JENSEN R A A, MUSAEUS P, PEDERSEN K. Virtual patients in undergraduate psychiatry education: a systematic review and synthesis[J]. Adv Health Sci Educ Theory Pract, 2024, 29(1): 329-347. doi: 10.1007/s10459-023-10247-6
[6]	陈元, 孙书珍, 成海燕, 等. 虚拟标准化病人用于儿科专业住院医师临床思维能力培养的探索[J]. 中国毕业后医学教育, 2023, 7(9): 749-752. CHEN Y, SUN S Z, CHENG H Y, et al. Exploration of clinical thinking ability training of pediatric residents using virtual standardized patients[J]. Chinese Journal of Graduate Medical Education, 2023, 7(9): 749-752.
[7]	BORG A, JOBS B, HUSS V, et al. Enhancing clinical reasoning skills for medical students: a qualitative comparison of LLM-powered social robotic versus computer-based virtual patients within rheumatology[J]. Rheumatol Int, 2024, 44(12): 3041-3051. doi: 10.1007/s00296-024-05731-0
[8]	金可, 任菁菁. 全科医生培养的中德对比及借鉴分析[J]. 中国全科医学, 2024, 27(19): 2330-2335. JIN K, REN J J. A comparison and analysis of Chinese and German practices in general practitioner training[J]. Chinese General Practice, 2024, 19(27): 2330-2335.
[9]	刘晓鹏, 张思森, 舒延章, 等. MDT联合PBL教学法在全科医师规范化培训中的研究与实践[J]. 中国高等医学教育, 2022(3): 91-92. LIU X P, ZHANG S S, SHU Y Z, et al. Research and practice of MDT combined with PBL teaching method in standardized training of general practitioners[J]. China Higher Medical Education, 2022(3): 91-92.
[10]	艾静, 孙远. CBL联合眼科多模式影像诊断在眼科及全科医学规培生培养教学中的应用[J]. 全科医学临床与教育, 2022, 20(1): 57-60. AI J, SUN Y. Application of CBL combined with ophthalmic multimodal imaging diagnosis in the standardized training of ophthalmic and general medicine students[J]. Clinical Education of General Practice, 2022, 20(1): 57-60.
[11]	谢吐秀, 吕菁君, 张新奇, 等. 基于ZOOM平台的CBL联合双语Seminar教学模式在全科住院医师规范化培训中的应用效果[J]. 中国医药导报, 2021, 18(25): 59-62. XIE T X, LYU J J, ZHANG X Q, et al. Application effect of CBL and bilingual Seminar teaching mode based on ZOOM platform in residency training of general practice[J]. China Medical Herald, 2021, 18(25): 59-62.
[12]	覃保瑜, 姚彦冰, 黄鸿. Mini-CEX联合DOPS在全科医师规范化培训中应用探索[J]. 右江医学, 2022, 50(6): 478-480. QIN B Y, YAO Y B, HUANG H. Application exploration of Mini-CEX combined with DOPS in standardized training of general practitioners[J]. Chinese Youjiang Medical Journal, 2022, 50(6): 478-480.
[13]	吴薇, 陈卓, 王小飞, 等. "新医科"背景下Mini-CEX量表在全科医学专业研究生住院医师规范化培训中的应用[J]. 沈阳医学院学报, 2022, 24(2): 209-212. WU W, CHEN Z, WANG X F, et al. Application of Mini-CEX scale in the standardized training of postgraduate residents in general medicine under the background of"new medicine"[J]. Journal of Shenyang Medical College, 2022, 24(2): 209-212.
[14]	周莹. H医院全科住院医师规范化培训体系优化研究[D]. 哈尔滨: 哈尔滨工程大学, 2023. ZHOU Y. Optimization research on the standardized training system of general practice residents in hospital H[D]. Harbin: Harbin Engineering University, 2023.
[15]	武艳菊. 河北省住院医师规范化培训临床基地全科师资现状调查研究[D]. 石家庄: 河北医科大学, 2023. WU Y J. Investigation and research on the current status of general practice faculty in the standardized training clinical bases for residents in Hebei Province[D]. Shijiazhuang: Hebei Medical University, 2023.
[16]	姜睿, 王永晨, 姜礼红, 等. 全科住院医师规范化培训考核体系的应用与评价研究[J]. 中国全科医学, 2020, 23(25): 3212-3215, 3219. JIANG R, WANG Y C, JIANG L H, et al. Application and evaluation of standardized general medicine residency training assessment system[J]. Chinese General Practice, 2020, 23(25): 3212-3215, 3219.
[17]	姜隽, 项渊月, 李晓雨, 等. 江苏省全科专业住院医师规范化培训基地的现状分析及对策[J]. 中国毕业后医学教育, 2021, 5(2): 182-185. JIANG J, XIANG Y Y, LI X Y, et al. Status analysis and countermeasures of the standardized training bases for general resident physicians in Jiangsu Province[J]. Chinese Journal of Graduate Medical Education, 2021, 5(2): 182-185.
[18]	孙雨哲, 王宪娥, 侯建霞. 虚拟标准化病人在医学教育中的应用与研究进展[J]. 中华医学教育杂志, 2024, 44(4): 294-298. SUN Y Z, WANG X E, HOU J X. Application and research progress of virtual standardized patients in medical education[J]. Chinese Journal of Medical Education, 2024, 44(4): 294-298.
[19]	张云红, 龙珑, 叶凤仙, 等. 不同教育背景标准化病人在全科专业住院医师规范化培训及考核中的运用[J]. 中国基层医药, 2023, 30(7): 1091-1094. ZHANG Y H, LONG L, YE F X, et al. Application of standardized patients under different educational backgrounds in standardized training and clinical examination among residents of general practice[J]. Chinese Journal of Primary Medicine and Pharmacy, 2023, 30(7): 1091-1094.
[20]	贺漫青, 曾多, 万学红, 等. 我国标准化病人和标准化病人培训师现状调查与问题分析[J]. 中华医学教育探索杂志, 2021, 20(6): 718-722. HE M Q, ZENG D, WAN X H, et al. Investigation on present status and problem analysis of standardized patients and standardized patient educators in China[J]. Chinese Journal of Medical Education Research, 2021, 20(6): 718-722.
[21]	周志浩, 宋佳琳, 刘嘉成, 等. 基于人工智能LLM技术的虚拟患者系统构建与临床教学应用[J]. 医学新知, 2024, 34(7): 833-842. ZHOU Z H, SONG J L, LIU J C, et al. Construction and clinical teaching application of virtual patient system: based on artificial intelligence LLM technology[J]. New Medicine, 2024, 34(7): 833-842.
[22]	YI Y J, KIM K J. The feasibility of using generative artificial intelligence for history taking in virtual patients[J]. BMC Res Notes, 2025, 18(1): 80. DOI: 10.1186/s13104-025-07157-8.
[23]	FUOAD S A, EL-SAYED W, MAREI H. Effect of different teaching/learning approaches using virtual patients on student' s situational interest and cognitive load: a comparative study[J]. BMC Med Educ, 2022, 22(1): 763. DOI: 10.1186/s12909-022-03831-8.
[24]	MERGEN M, GRAF N, MEYERHEIM M. Reviewing the current state of virtual reality integration in medical education-a scoping review[J]. BMC Med Educ, 2024, 24(1): 788. DOI: 10.1186/s12909-024-05777-5.
[25]	BORG A, GEORG C, JOBS B, et al. Virtual patient simulations using social robotics combined with large language models for clinical reasoning training in medical education: mixed methods study[J]. J Med Internet Res, 2025, 27: e63312. DOI: 10.2196/63312.
[26]	KONONOWICZ A A, WOODHAM L A, EDELBRING S, et al. Virtual patient simulations in health professions education: systematic review and meta-analysis by the digital health education collaboration[J]. J Med Internet Res, 2019, 21(7): e14676. DOI: 10.2196/14676.
[27]	HAMILTON A. Artificial intelligence and healthcare simulation: the shifting landscape of medical education[J]. Cureus, 2024, 16(5): e59747. DOI: 10.7759/cureus.59747.
[28]	阳盼, 张璟璐, 李晋芳, 等. 虚拟病人在全科医患沟通能力培养中的应用[J]. 岭南急诊医学杂志, 2022, 27(5): 499-500. YANG P, ZHANG J L, LI J F, et al. Application of virtual patients in the training of general practitioners ' doctor-patient communication skills[J]. Lingnan Journal of Emergency Medicine, 2022, 27(5): 499-500.
[29]	ASGHAR M S, ZAMAN B S, ZAHID A. Past, present, and future of surgical simulation and perspective of a developing country: a narrative review[J]. J Pak Med Assoc, 2021, 71(12): 2770-2776. DOI: 10.47391/JPMA.01-1046.
[30]	OLIVEN A, NAVE R, BARUCH A. Long experience with a web-based, interactive, conversational virtual patient case simulation for medical students ' evaluation: comparison with oral examination[J]. Med Educ Online, 2021, 26(1): 1946896. DOI: 10.1080/10872981.2021.1946896.
[31]	高阳, 赵沁平, 周学东, 等. 虚拟现实技术在新医科人才培养中的作用及应用现状[J]. 四川大学学报(医学版), 2021, 52(2): 182-187. GAO Y, ZHAO Q P, ZHOU X D, et al. The Role of Virtual Reality Technology in Medical Education in the Context of Emerging Medical Discipline[J]. Journal of Sichuan University(Medical Sciences), 2021, 52(2): 182-187.
[32]	吴芳, 苏壮志, 孙峥, 等. 人工智能辅助教学在医学影像规范化培训中的应用及探索[J]. 医学教育管理, 2023, 9(6): 746-751. WU F, SU Z Z, SUN Z, et al. Application and exploration of the artificial intelligence assisted teaching in standardized training program for medical imaging[J]. Medical Education Management, 2023, 9(6): 746-751.
[33]	徐佩芳, 叶娟. "人工智能+教育"在眼科住院医师规范化培训中的应用与思考[J]. 浙江医学教育, 2024, 23(1): 29-33. XU P F, YE J. The application and thinking of"artificial intelligence+education"in the standardized training of ophthalmic residents[J]. Zhejiang Medical Education, 2024, 23(1): 29-33.
[34]	SAFRANEK C W, SIDAMON-ERISTOFF A E, GILSON A, et al. The role of large language models in medical education: applications and implications[J]. JMIR Med Educ, 2023, 9: e50945. DOI: 10.2196/50945.
[35]	OH S R, SEO Y D, LEE E, et al. A comprehensive survey on security and privacy for electronic health data[J]. Int J Environ Res Public Health, 2021, 18(18): 9668. DOI: 10.3390/ijerph18189668.
[36]	WATARI T, TOKUDA Y, OWADA M, et al. The utility of virtual patient simulations for clinical reasoning education[J]. Int J Environ Res Public Health, 2020, 17(15): 5325. DOI: 10.3390/ijerph17155325.
[37]	KIESEWETTER J, SAILER M, JUNG V M, et al. Learning clinical reasoning: how virtual patient case format and prior knowledge interact[J]. BMC Med Educ, 2020, 20(1): 73. DOI: 10.1186/s12909-020-1987-y.
[38]	任菁菁. 全科医学进展[M]. 北京: 高等教育出版社, 2022: 1-5. REN J J. Progress of general practice[M]. Beijing: Higher Education Press, 2022: 1-5.
[39]	陈明敏, 刘颖, 任菁菁. 叙事医学在全科医学领域的应用现状与进展[J]. 中华医学杂志, 2020, 100(8): 635-637. CHEN M M, LIU Y, REN J J. Current status and progress of narrative medicine in the field of general practice[J]. National Medical Journal of China, 2020, 100(8): 635-637.
[40]	张俊祥, 李传富, 吕维富. 人工智能在医学教育、科研和临床实践中的应用前景与挑战[J]. 中华全科医学, 2024, 22(7): 1085-1089. doi: 10.16766/j.cnki.issn.1674-4152.003572 ZHANG J X, LI C F, LYU W F. The application prospects and challenges of artificial intelligence in medical education, medical research, and clinical practice[J]. Chinese Journal of General Practice, 2024, 22(7): 1085-1089. doi: 10.16766/j.cnki.issn.1674-4152.003572