The contribution of simulated patients to meaningful student learning

Development of a validated assessment tool for medical students using simulated patients: an 8-year panel survey

BACKGROUND

The use of simulated patients (SPs) to assess medical students' clinical performance is gaining prominence, underscored by patient safety perspective. However, few reports have investigated the validity of such assessment. Here, we examined the validity and reliability of an assessment tool that serves as a standardized tool for SPs to assess medical students' medical interview.

METHODS

This longitudinal survey was conducted at Keio University School of Medicine in Japan from 2014 to 2021. To establish content validity, the simulated patient assessment tool (SPAT) was developed by several medical education specialists from 2008 to 2013. A cohort of 36 SPs assessed the performance of 831 medical students in clinical practice medical interview sessions from April 2014 to December 2021. The assessment's internal structure was analyzed using descriptive statistics (maximum, minimum, median, mean, and standard deviation) for the SPAT's 13 item total scores. Structural validity was examined with exploratory factor analysis, and internal consistency with Cronbach's alpha coefficients. The mean SPAT total scores across different SPs and scenarios were compared using one way analysis of variance (ANOVA). Convergent validity was determined by correlating SPAT with the post-clinical clerkship obstructive structured clinical examination (post-CC OSCE) total scores using Pearson's correlation coefficient.

RESULTS

Of the 831 assessment sheets, 36 with missing values were excluded, leaving 795 for analysis. Thirty-five SPs, excluding one SP who quit in 2014, completed 795 assessments, for a response rate of 95.6%. Exploratory factor analysis revealed two factors, communication and physician performance. The overall Cronbach's alpha coefficient was 0.929. Significant differences in SPAT total scores were observed across SPs and scenarios via one-way ANOVA. A moderate correlation (r =.212, p <.05) was found between SPAT and post-CC OSCE total scores, indicating convergent validity.

CONCLUSIONS

Evidence for the validity of SPAT was examined. These findings may be useful in the standardization of SP assessment of the scenario-based clinical performance of medical students.

How simulated patients contribute to student learning in an authentic way, an interview study

INTRODUCTION

Simulated patients (SPs) play an instrumental role in teaching communication skills and enhancing learning outcomes. Prior research mostly focused on the SP's contribution to students' learning outcomes by providing feedback afterwards. A detailed understanding of the contribution of the SP during SP-student encounters is currently lacking although the majority of the interaction between SPs and students occurs during the SP-student encounter. Therefore, this study focuses on how SPs see their contribution to meaningful student learning experiences during SP-student encounters.

METHODS

We interviewed fifteen simulated patients from one institution. We explored their perspectives on meaningful learning experiences during SP-student encounters through in-depth, semi-structured interviews and analyzed using thematic analysis.

RESULTS

SPs view their contribution to meaningful student learning during SP-student encounters from two perspectives. A collective perspective as a member of the community of SPs and an individual perspective. From the collective perspective, SPs believe that the fact that students deal with multiple varied SP-student encounters over time is of value for meaningful learning. From the individual perspective, we noticed that SPs think, act, and react from three different positions. First, as the patient in the role description, second, as a teaching aid and third, as an individual with personal experiences, beliefs, and values. SPs mentioned that the ratio between these different positions can vary within and between encounters.

CONCLUSIONS

According to SPs, we should value the variation between SPs, thereby creating meaningful variation in authentic interactions in SP-student encounters. SPs should be allowed to act and react from different positions during SP-student encounters, including their role description, as teaching aid, and based on their own experiences. In this way, SP-student encounters are optimized to contribute to meaningful student learning through authenticity.

"Fit for the finals" - project report on a telemedical training with simulated patients, peers, and assessors for the licensing exam

Background

Undergraduate medical students take the licensing exam (M3) as a two-day oral-practical examination. The main requirements are to demonstrate history taking skills and coherent case presentations. The aim of this project was to establish a training in which students can test their communication skills during history taking and their clinical reasoning skills in focused case presentations.

Methods

In the newly developed training, final-year students took four telemedical histories in the role of physicians from simulated patients (SP). They received further findings for two SPs and presented these in a handover, in which they also received a handover of two SPs which they had not seen themselves. Each student presented one of the two received SPs in a case discussion with a senior physician. Feedback was given to the participants on their communication and interpersonal skills by the SPs with the ComCare questionnaire and on the case presentation by the senior physician. Sixty-two students from the universities of Hamburg and Freiburg in their final year participated in September 2022 and evaluated the training.

Results

Participants felt that the training was very appropriate for exam preparation. The SPs' feedback on communication and the senior physician's feedback on clinical reasoning skills received the highest ratings in importance to the students. Participants highly valued the practice opportunity for structured history taking and case presentation and would like to have more such opportunities in the curriculum.

Conclusion

Essential elements of the medical licensing exam can be represented, including feedback, in this telemedical training and it can be offered independent of location.

Three perspectives on learning in a simulated patient scenario: a qualitative interview study with student, simulated patient, and teacher

INTRODUCTION

Patient simulation can be useful for medical students in developing communication skills for vulnerable situations. Three participants are primarily involved in the patient simulation activities: the student, the simulated patient (SP), and the teacher. We here aimed to explore these participants' perceptions of learning in a patient simulation scenario.

METHODS

We conducted individual interviews with eight students, three teachers, and one SP at a psychiatry placement of a Medical Doctor Program (5th year). During the interviews we asked the participants to watch a video of their participation in a patient simulation session. Thus, we obtained three perspectives on each of the eight recordings. We analysed our data with qualitative content analysis.

RESULTS

Three themes were generated: identity formation, collaborative learning, and learning intentions. This highly emotional scenario forced students out of their comfort zone, to the intersection of their roles as private person and professional. The SP perceived the collaborative creation of the scenario as significant learning. The teacher took a professional position and perceived the learning in the perspective of a future colleague.

CONCLUSIONS

The mutually created emotionally loaded scenario was found to be important from all three perspectives, forcing the students to identify unexpected ways of communicating. This possibly enhanced their professional identity development. Implications for future research can be to explore the process of skills transfer.

Influence of using simulated or real patients on undergraduate medical students acquiring competencies in medical conversations in surgery: A prospective, controlled study

Background

Communication with patients and their relatives as well as with colleagues and students is an essential part of every physician's daily work. An established method for teaching communication skills is using simulated patients (SPs). However, teaching with SPs is often subjectively perceived by medical students as less instructive than teaching with real patients (RPs). Studies that analyze the influence of SPs compared to RPs for acquiring competencies are lacking. The aim of the present study was therefore to investigate the impact of SPs on long-term learning success for communication skills compared to RPs.

Material and Methods

Study participants were undergraduate third-year medical students who attended a communication unit and were randomized into three groups. The first group trained the role-play part with a SP (SP-group). The second group trained with a SP but thought that the patient was a RP because the students and the tutors were told that they were a RP by the principal investigator (incognito patient group [IP-group]). The third group and their tutors trained with a RP and were told that the patient was a RP (real patient group [RP-group]). Five to 12 weeks after completing the training, the study participants completed a curricular summative objective standardized clinical examination.

Results

There were 146 students who participated in the study. There were no significant differences between the three study groups at the informed consent stations and for those conducting anamnesis interviews.

Conclusion

Communication skills training with SPs appears to be equivalent to training with RPs in terms of competency development in communication-based assessments in surgery. Therefore, SPs should be used in these curricula, especially at an early stage, to enable the students to practice adequate communication skills.

A Study of Differences in Compulsory Courses Offering Medicine Humanization and Medical Communication in Polish Medical Schools: Content Analysis of Secondary Data

Medical humanity is an essential element of medical education, and the respective courses are introduced to the curricula of medical schools worldwide. However, significant differences in this type of medical education were identified in Italy, Spain, and the UK. In Poland, this issue was not yet analyzed. The classes offered on a compulsory and not elective basis secure the uniform skills of future physicians. Therefore, we were prompted to ask a question: do Polish medical students receive equal compulsory education in medical humanities? To answer that question, we performed a content analysis of mandatory classes’ frequency, types, and content on medical humanization and communication in Polish medical schools. The study used publicly available information provided on the home pages of the universities to perform content and comparative analyses. Of 22 identified universities, 15 had publicly listed teaching programs, and nine had freely available syllabi. The names and types of courses varied from school to school. The number of hours the courses offered throughout medical education ranged from 15 to 216. In some medical schools, the classes were scheduled during the early, pre-clinical part of the study, whereas in other schools they were offered each year. The content of the courses always covered the topics of physician–patient communication but rarely offered protocols, such as the Calgary Cambridge guide. We conclude that the medical humanities represented by medical humanization and communication courses are included in the publicly available compulsory curriculum of most Polish medical schools. However, to secure equal education of future Polish physicians, there is a need to unify the medical humanities program.