中華心理衛生協會

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. Role-play 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.