Real patient involvement in role development: evaluating patient focused resources for clinical procedural skills

Diabetic foot workshop: A strategy for improving the knowledge of diabetic foot care providers

BACKGROUND AND AIMS

Prevention and management of diabetic foot ulcer have essential effects on the quality of life of patients. Accordingly training the care providers can play an essential role in reducing complications foot ulcers and lead to an increase in the effectiveness and efficiency of patient health cares. We conducted a study to survey the impact of the diabetic foot workshop on the knowledge of nurses and physicians about diagnosis and managing diabetic foot.

METHODS

The present study is a quasi-experimental which compare the knowledge of non-randomized group of nurses and physicians about diabetic foot care. The leaning objectives, agenda, contents and evaluation methods of the diabetic foot care workshop was designed by a multidisciplinary team members in form of 2 days workshop. Each topic of the workshop presented theoretically and practically using educational cases and real patient with diabetic foot ulcer. A valid and reliable questionnaire with 20 Multiple Choice Questions used for the evaluation of workshopin form of the pretest and posttest.

RESULTS

In this study, 396 registered nurses and physicians participates in the diabetic foot workshop series. The results of this study showed that this increase in the level of knowledge was meaningful after the educational intervention since the mean of the posttest score increased more than 20% comparing with pretest.

CONCLUSION

The promotion of knowledge of health care providers as shown in the study may almost be due to training by real patient, team-working, and using educational movies for the education of diabetic foot diagnosis, management and rehabilitation.

Nothing about me without me: a scoping review of how illness experiences inform simulated participants' encounters in health profession education

Background

Person-centred simulation in health professions education requires involvement of the person with illness experience.

Objective

To investigated how real illness experiences inform simulated participants' (SP) portrayals in simulation education using a scoping review to map literature.

Study selection

Arksey and O'Malley's framework was used to search, select, chart and analyse data with the assistance of personal and public involvement. MEDLINE, Embase, CINAHL, Scopus and Web of Science databases were searched. A final consultation exercise was conducted using results.

Findings

37 articles were within scope. Reporting and training of SPs are inconsistent. SPs were actors, volunteers or the person with the illness experience. Real illness experience was commonly drawn on in communication interactions. People with illness experience could be directly involved in various ways, such as through conversation with an SP, or indirectly, such as a recording of heart sounds. The impact on the learner was rarely considered.

Conclusion

Authentic illness experiences help create meaningful person-centred simulation education. Patients and SPs may both require support when sharing or portraying illness experience. Patients' voices profoundly enrich the educational contributions made by SPs.

Physiotherapy students can be educated to portray realistic patient roles in simulation: a pragmatic observational study

BACKGROUND

Simulation-based education (SBE) has many benefits for learners, but costs can limit embedding SBE in health professional curricula. Peer simulation involves students portraying patient roles, and may reduce costs while still providing the benefits of other SBE experiences. However, the quality of the SBE may be impacted if students cannot portray authentic and realistic patient roles. The aim of this study was to investigate whether targeted education was associated with observable changes to physiotherapy students' abilities to portray patient roles in SBE.

METHODS

Second year pre-registration physiotherapy students (n = 40) participated. Students completed online and face-to-face education about SBE, patient portrayal skills, and how to portray a specific patient role. Students were video-recorded portraying patient roles in practical exams before and after the program. Three blinded independent assessors rated the overall quality of portrayals using a purpose-developed assessment instrument.

RESULTS

Twenty-three sets of pre- and post-program videos were analysed. Correlations between assessor scores spanned 0.62 to 0.82 for analyses of interest, which justified using average assessor ratings in analysis. Statistically significant higher scores were seen for post-program assessments for overall portrayal scores (mean difference 6.5, 95%CI [1.51-11.45], p = 0.013), accuracy (mean difference 3.4, 95%CI [0.69-6.13], p = 0.016) and quality (mean difference 3.1, 95%CI [0.64-5.49], p = 0.016).

CONCLUSIONS

Physiotherapy students appear capable of playing realistic patient roles. Peer simulation can be embedded into health professional programs, and education in patient role portrayal appears to be associated with improvements in portrayal quality and realism. Given these findings, further investigation, including testing program effects in a randomised study, is warranted.

Pharmacists' experiences and perceptions about simulation use for learning and development of clinical skills in Kuwait

Background There has been a worldwide exponential rise in simulation use in health professions education. Most of the evidence about simulation-based education (SBE) comes from Western educational systems. Little is known about simulation use in the education and training of pharmacy students and pharmacists in the Middle Eastern countries. Objective To explore pharmacists' experiences, perceptions and attitudes toward simulation use for learning clinical skills in Kuwait. Setting Different governmental hospitals across the State of Kuwait. Method This was an exploratory descriptive study of pharmacists' perceptions about SBE. A mixed-method research design was employed whereby 110 hospital pharmacists participated in focus groups and completed self-administered surveys. The focus group interviews were audio-recorded, transcribed verbatim and analysed using framework analysis. Descriptive statistics were used to describe characteristics of study participants and survey findings. Main outcome measure Pharmacists' experiences, perceptions and attitudes toward SBE. Results A total of 110 pharmacists participated in the focus groups, of whom 88 completed the survey (80% response rate). The focus groups revealed that pharmacists had different experiences in relation to simulation use which included learning, assessment, and less frequently reported in their training as practitioners. They identified many benefits of simulation such as enhancing knowledge retention and allowing learners practice and rehearse clinical skills in safe environments. Participants' perceived barriers to simulation use in pharmacy students' training included the need for qualified faculty and simulated patients, time constrains to incorporate simulation in faculty teaching and reluctance of learners/educators to use simulation. Most participants expressed positive attitudes toward simulation and welcomed its integration in pharmacy students' learning. In response to survey, 26.1% of pharmacists reported having no prior experience in the use of simulation. The top reported barriers to using simulation for learning were time constrains (22.7%) and the need for qualified faculty (6.8%). Conclusion Pharmacists in Kuwait have diverse experiences regarding simulation use for learning. They expressed positive attitudes toward simulation use for learning clinical skills. Efforts are needed to standardize and expand simulation use in the education and training of pharmacy students, trainees and practitioners to equip them with the clinical skills essential for pharmacy practice.

Patient involvement in health professionals' education: a meta-narrative review

More than 100 years ago, Osler inspired educators to consider health professions education (HPE) as intricately reliant on patients. Since that time, patient involvement in HPE has taken on many different meanings. The result is a disparate body of literature that is challenging to search, making it difficult to determine how to continue to build knowledge in the field. To address this problem, we conducted a review of the literature on patient involvement in HPE using a meta-narrative approach. The aim of the review was to synthesize how questions of patient involvement in HPE have been considered across various research traditions and over time. In this paper, we focus on three scholarly communities concerned with various interpretations of patient involvement in HPE-patient as teachers, real patients as standardized patients, and bedside learning. Focus on these three research communities served as a way to draw out various meta-narratives in which patients are thought of in particular ways, specific rationales for involvement are offered, and different research traditions are put to use in the field. Attending to the intersections between these meta-narratives, we focus on the potentially incommensurate ways in which "active" patient engagement is considered within the broader field and the possible implications. We end by reflecting on these tensions and what they might mean for the future of patient involvement, specifically patient involvement as part of future iterations of competency based education.

Simulated Patients Are Predominantly Used to Teach and Evaluate Athletic Training Students' Skills: A 10-Year Follow-Up

Context:

Health care education needs to include methods of teaching and evaluation that are realistic and mimic patient care.

Objective:

To follow up on previous research regarding the methods athletic training educators use to evaluate and teach athletic training students' clinical skills during clinical experiences and in the classroom/laboratory.

Design:

Cross-sectional.

Setting:

Public and private institutions.

Patients or Other Participants:

Program directors of all accredited professional athletic training programs as of November 2015 (N = 372) were asked to participate; a total of 90 participated.

Data Collection and Analysis:

The electronic survey consisted of 6 demographic questions, 6 questions regarding methods used to teach and evaluate clinical skills, and 6 items regarding barriers, educational content areas, and practice settings for real-time patient encounters. The Cronbach α determined internal consistency, α = 0.784. Descriptive statistics were computed for all items. An analysis of variance and independent t tests analyzed differences among institutions/programs with different demographic characteristics with regard to methods, barriers, educational content areas, and settings used for teaching and evaluating skills. The α level was set at .05.

Results:

Simulated patients and real-time evaluations were the most prevalent methods of teaching and evaluating clinical skills in the classroom/laboratory and during clinical experiences, respectively. Students' lack of self-confidence (4.10 ± 0.835) was the most common barrier during clinical experiences. The clinical examination and diagnosis (4.54 ± 0.656) and acute care of injury and illness (4.39 ± 0.775) content areas ranked highest for sufficient opportunities for real-time skill evaluation. One-way analysis of variances revealed no significant differences related to institutional/program demographics regarding opportunities for or barriers to teaching and evaluating skills.

Conclusions:

Ten years after our previous research, athletic training students' skills are still primarily taught and evaluated via simulated patients, with a slight increase in real-time patient encounters. Professional programs should continue using simulations and consider real-time encounters to provide additional patient care experiences.

'Can the patient speak?': postcolonialism and patient involvement in undergraduate and postgraduate medical education

CONTEXT

Patients are increasingly being engaged in providing feedback and consultation to health care institutions, and in the training of health care professionals. Such involvement has the potential to disrupt traditional doctor-patient power dynamics in significant ways that have not been theorised in the medical literature. Critical theories can help us understand how power flows when patients are engaged in the training of medical students.

METHODS

This paper applies postcolonial theory to the involvement of patients in the development and delivery of medical education. First, I review and summarise the literature around patient involvement in medical education. Subsequently, I highlight how postcolonial frameworks have been applied to medical education more broadly, extrapolating from the literature to apply a postcolonial lens to the area of patient engagement in medical education.

CONCLUSION

Concepts from postcolonial theory can help medical educators think differently about how patients can be engaged in the medical education project in ways that are meaningful and non-tokenistic. Specifically, the positioning of the patient as 'subaltern' can provide channels of resistance against traditional power asymmetries. This has curricular and methodological implications for medical education research in the area of patient engagement.

Engaging patients and clinicians through simulation: rebalancing the dynamics of care

This paper proposes simulation-based enactment of care as an innovative and fruitful means of engaging patients and clinicians to create collaborative solutions to healthcare issues. This use of simulation is a radical departure from traditional transmission models of education and training. Instead, we frame simulation as co-development, through which professionals, patients and publics share their equally (though differently) expert perspectives. The paper argues that a process of participatory design can bring about new insights and that simulation offers understandings that cannot easily be expressed in words. Drawing on more than a decade of our group's research on simulation and engagement, the paper summarises findings from studies relating to clinician-patient collaboration and proposes a novel approach to address the current need. The paper outlines a mechanism whereby pathways of care are jointly created, shaped, tested and refined by professionals, patients, carers and others who are affected and concerned by clinical care.

Exploration of the attitudes of nursing students to peer physical examination and physical examination of patients

BACKGROUND

The use of peer physical examination (PPE) in early clinical skills has been studied amongst medical students. The majority of students are comfortable with using peer physical examination, when sensitive areas are excluded. Students' attitudes are related to their personal characteristics: gender, age, religious faith, and ethnicity. There is no data on nursing students' attitudes to peer physical examination.

OBJECTIVES

Identify and explore:

DESIGN

Dual cohort, cross-sectional, anonymous survey.

SETTING

Three-year undergraduate nursing programme, skills centre and service clinical learning.

METHODS

All first and third year nursing students were asked to complete a modified Examining Fellow Students questionnaire at the end of 2008. The questionnaire asked students to indicate which of 12 body areas they would not be willing to examine/have examined by a peer of the same/opposite gender. This study also asked students which of the 12 body areas they felt uncomfortable examining on patients.

RESULTS

The response rate was 76% (128/168). The students were predominantly female (93% female; 7% male). Most students were comfortable with examining non-sensitive body regions of peers (78.2%-100% willing) and patients (92.3-100% willing). Male gender was significantly associated with willingness to examine and be examined by peers (p=0.001); Asian students were significantly less willing to engage in peer physical examination with opposite gender (p<0.007). Year 3 students were significantly more comfortable than Year 1 in examining patients of either gender (p<0.001).

DISCUSSION AND CONCLUSIONS

In spite of the male gender findings, this predominantly female population expresses similar attitudes to the gender-balanced medical student studies - high acceptability for non-sensitive areas. The role of characteristics and attitudes to peer physical examination shows similarities and differences to other studies. Student characteristics were not related to patient examination attitudes.

Keeping it real! Enhancing realism in standardised patient OSCE stations

BACKGROUND

Objective structured clinical examinations (OSCEs) are a commonly used method of assessing clinical competency in health care education. They can provide an opportunity to observe candidates interacting with patients. There are many challenges in using real patients in OSCEs, and increasingly standardised patients are being used as a preference. However, by using standardised patients there is a risk of making the encounter artificial and removed from actual clinical practice.

CONTEXT

Efforts made in terms of cognitive, auditory, visual, tactile, psychological and emotional cues can minimise the differences between a simulated and real clinical scenario. However, a number of factors, including feasibility, cost and usability, need to be considered if such techniques are to be practicable within an OSCE framework.

INNOVATION

This article describes a series of techniques that have been used in our institution to enhance the realism of a standardised patient encounter in an OSCE. Efforts in preparing standardised patient roles, and how they portray these roles, will be considered. A wide variety of equipment can also be used in combination with a patient and the surrounding environment, which can further enhance the authenticity of the simulated scenario.

IMPLICATIONS

By enhancing the realism in simulated patient OSCE encounters, there is potential to trigger more authentic conscious responses from candidates and implicit reactions that the candidates themselves may be less aware of. Furthermore, using such techniques may allow faculty members to select scenarios that were previously not thought possible in an OSCE.

Defining responsibilities of simulated patients in medical education

BACKGROUND

Simulated patients (SPs) play a critical role in medical education. The development of SP methodology has resulted in wide ranging responsibilities. For SPs to work effectively, we believed it was important to clearly articulate their responsibilities, and that this would be best achieved by consultation with all stakeholders-SPs, students, tutors, and administrators.

METHODS

As part of a quality assurance initiative, we designed a questionnaire and focus group study to explore stakeholders' perceptions of the responsibilities of SPs in teaching. Convenience and purposive sampling was used to recruit participants to questionnaires and focus groups, respectively. Data were analyzed thematically.

RESULTS

Eighty-six questionnaires were collected, and six focus groups were conducted. Five sets of guidelines on responsibilities were produced. In addition, guidelines were established for feedback that SPs and tutors could use to maximize impact.

DISCUSSION

The results highlight the complexity of SP-based teaching. Clarification of all stakeholders' responsibilities demonstrates the importance of a team approach to SP-based teaching. Focusing attention on just one set of stakeholder's responsibilities is unlikely to improve perception of quality. The process for developing the guidelines may be valuable for those who work with SPs. Stakeholder engagement is likely to ensure greater commitment than those developed by faculty.

Perspective: authentic patient perspectives in simulations for procedural and surgical skills

In this article, the authors consider the role of the patient in simulation-based training and assessment of clinical procedural skills. In recent years, there has been a progressive shift of emphasis from teacher-centered to student-centered education, resulting in a redefinition of approaches to medical education. Traditional models of transmission of information from an expert to a novice have been supplanted by a more student-centered approach. However, medical education is not a matter for teacher and student alone. At the center is always the patient, around whom everything must ultimately rotate. A further shift is occurring. The patient is becoming the focal point of medical teaching and learning. It is argued that this shift is necessary and that simulation in its widest sense can be used to support this process. However, sensitivity to what we are simulating is essential, especially when simulations purport to address patient perspectives. The essay first reviews the history of medical education "centeredness," then outlines ways in which real and simulated patients are currently involved in medical education. Patient-focused simulation (PFS) is described as a means of offering patients' perspectives during the acquisition of clinical procedural and surgical skills. The authors draw on their experiences of developing PFS and preliminary work to "authenticate" simulations from patient perspectives. The essay concludes with speculation on the value of a "complementarity" model that acknowledges the authentic and equal perspectives of patients, students, clinicians, and teachers.

Practica continua: Connecting and combining simulation modalities for integrated teaching, learning and assessment

Simulation modalities are generally used independently of one another, largely due to physical and operational limitations to integration. Recent developments are enabling simulators and simulation environments to progress beyond single intervention models towards integrated continua of simulation. Moving to greater integration can improve contextualisation, better management of the transition from individual simulation to clinical practice, and provide wider opportunities to synthesise skills and approaches to practice. Simulation integration may involve experiential, modelling, technical, narrative, and evaluation dimensions; it includes both direct actions and activities, and technical and systems designs. The work in developing these integration continua is ongoing and takes many forms in many places. The framework of 'practica continua' proposed in this article links theoretical approaches and practical examples of integrated uses of simulation in education.