情境學習導向的臨床心理學教育：標準化病人訓練之應用與挑戰

The Situated Learning Approach in Clinical Psychology Education: The Use and Challenge of the Standardized Patient Training Method

研究目的：近幾年台灣臨床心理學界開始對臨床心理師的教育訓練議題進行重要的反思，開始強調專業能力（competence）的重要性，並希望能縮短學校教育與實務界需求之落差。本文試圖探討符合情境學習理論精神的「標準化病人訓練」方法，提出應用在臨床心理學實務技能訓練之可行性。研究方法：本文以文獻回顧方式，依（1）情境學習導向的訓練、（2）標準化病人訓練及（3）「標準化病人訓練」在臨床心理學的應用等三部分內容加以整理分析。研究結果：情境學習強調透過社會文化脈絡中的真實情境及周邊參與來學習實用知能，這是學習臨床實務技能的必要途徑。目前臨床心理學多以角色扮演及臨床實習等方法來訓練臨床技能，但角色扮演在模擬臨床情境的真實性上並不理想，臨床實習也有學生臨場能力準備不足及無法客觀評估實習成效的困難。「標準化病人訓練」強調互動性及一致可信的特性，正可用來彌補現階段台灣臨床心理學教育訓練之不足。研究結論：「標準化病人訓練」透過模擬真實的臨床情境，可提供熟練溝通晤談技巧的臨床訓練，其一致可信的特性也可成為臨床能力的客觀評估工具，標準化病人的應用可為臨床心理學建構一套實徵導向的教學與能力評估方法。

Purpose: Clinical psychology in Taiwan, like other health science professions, has recently started to emphasize the importance of competency-based education and training, and has attempted to close the gap between the competence learned in school and that required in clinical practice. This competency-based movement has occurred in concert with a paradigm shift in education, which has entailed greater attention to the concept of situated learning and situated cognition. This article reviewed situated learning theories and application and the shortcomings of current psychological education, and proposed that standardized patient training (SPT) could be a possible alternative to current training methods. Methods: A literature review was conducted. Three topics were addressed: (1) the situated learning approach for psychology; (2) standardized patient training; and, (3) the use and challenges of the standardized patient training method in clinical psychology. Results: Situated leaning theories emphasize that learning is embodied in one’s social and cultural context through peripheral participation in real-life practices. It is essential in clinical psychology education to help students obtain fundamental clinical skills and abilities. Roleplay and clinical internship have been the two most used situated learning methods in Taiwan’s current clinical psychology training programs, but they are vulnerable to certain shortcomings. The biggest problem with role-playing is the lack of authenticity when students role-play patients or clients in clinical situations. A clinical internship is designed to let students learn clinical skills through real clinical encounters with patients and clients, although there is the risk of harm when students are not well-prepared in their clinical skills before beginning the internship. Another limitation of internships is the difficulty of observing students’ clinical skills in a valid and reliable way during the internship and objectively evaluating students’ abilities at its conclusion. Standardized patient training, another form of situated learning, could bridge the learning gap between role-playing and a clinical internship in clinical psychology training. The advantages of SPT over role-play are that standardized patients are specifically trained to authentically simulate the real clinical situations and therapist-client encounters and that they offer effective clinical training for interpersonal communication and interviewing skills. The consistent and credible performance of standardized patients could also serve as an objective assessment to evaluate students’ competence at the end of their internship. Possible applications of SPT in teaching clinical skills are discussed, including the use of SPT in teaching clinical intake interviews, risk assessment, and other sensitive clinical situations. The challenges of using SPT in clinical psychology are also stressed. These include high program costs and the difficulty of training highly psychologically and emotionally complex standardized patient roles. Conclusions: SPT is a possible alternative to current clinical psychology training to enhance students’ clinical skills. Future research should include the development of a training program specifically for psychologically and emotionally complex standardized patient roles (e.g., psychiatric patients), the possible impact of emotional distress in playing a psychiatric patient, the development of evidence-based clinical psychology training programs, and the development of an objective assessment tool for clinical skills using standardized patients.