Learning clinical skills - the place of simulation and feedback

Intra-operative consultation: The benefits and optimization of asking for second surgical opinions

BACKGROUND

Intra-operative consultation (IOC) presents an opportunity for successful collaboration around direct patient care in an unanticipated fashion. Besides technical performance and cognitive guidance, successful IOC benefits from incorporating a blend of non-technical skills (NTS) such as communication, teamwork, and decision-making during the ideally supportive episode. Failure to use such skills may lead to untoward consequences for the surgeon who requests IOC despite successful patient rescue.

OBJECTIVE

This narrative review explores the role of NTS within the context of IOC, particularly focusing on the dynamics between the surgeon seeking assistance and the surgeon providing aid.

METHODS

A comprehensive literature search was performed using PubMed and OVID Medline, covering publications up to January 2024. Search terms included "non-technical skills," "intra-operative consultation," "conflict management in surgery," and "surgical teamwork." Manuscript selection was based on relevance to NTS within the context of IOC. The findings were synthesized to craft a narrative review of the importance of NTS during IOCs.

RESULTS

IOC setting variability reflects consulting surgeon experience, case complexity, intra-operative events, resource availability, and responding surgeon specialty. Essential expectations for both the consulting and responding surgeon include embracing a collegial, non-judgmental approach that prioritizes patient safety and team cohesion. Strategies for conflict management-effective communication, active listening, and appropriate non-verbal cues-are readily leveraged to establish a supportive environment during IOC. Additionally, cultural elements - such as the reluctance to seek help due to fear of potential reputational damage - stand as barriers to viewing requesting IOC as a hallmark of maturity and professional practice.

CONCLUSIONS

NTS supports effective and successful IOC, positioning it as a valuable tool for ongoing professional development. By fostering a culture of consultation and collaboration, the surgical community can enhance both patient care and surgeon well-being. Incorporating NTS into surgical training is one means by which to adaptively overcome existing cultural barriers which impede IOC and may asymmetrically impact early career surgeons.

Veterinary undergraduates' attitudes to and understanding of clinical skills learning

BACKGROUND

The study investigated student understanding of development of their clinical skills learning, focusing on personal experiences of the learning strategies they employ and their experiences of judging their own competency, integrating skills and transferring skill knowledge.

METHODS

Twenty-nine veterinary students from two veterinary schools took part in semi-structured interviews investigating their perceptions of clinical skills importance and development. Thematic analysis of transcribed interviews was used for data analysis.

RESULTS

Themes that were developed were: (1) Students understand clinical skills to be individual technical practical skills but also understand how skills are combined to achieve complex tasks. (2) Students understand the concept of competency development and learn skills, review their progress and self-audit their skill competency in similar ways throughout the course. (3) Personal confidence, success and positive communication with peers and supervisors are critical to learn clinical skills.

CONCLUSION

Students understand clinical skills learning and use reflective skills widely to track developing skills competency. Prioritising individual feedback within practical sessions and training on integration of skills and communicating with supervisors ahead of clinical placements would be beneficial. Training in clinical skills study techniques, reflection and resilience will enable students to be proactive and to manage their feelings around uncertainty.

Simulated Patients for Competency-Based Undergraduate Medical Education Post COVID-19: A New Normal in India

The conventional medical curriculum in India needed more focus on explicit teaching and assessment of interpersonal and communication skills, professionalism, team-work and reflection for prevention and better management of increasing incidences of violence against doctors by building good doctor-patient relationships. Increasing number of seats in Indian medical colleges, decreasing hospital stay of patients, and decrease in faculty requirements will hamper adequate supervised authentic clinical experiences of undergraduates for developing clinical skills. The recent COVID-19 pandemic has led to a significant decrease in student-patient encounters. Simulated patients are being used in many countries to address many of these issues. To make the Indian medical graduates competent to function as primary physician of first contact, competency-based medical education along with guidelines for use of skill-lab and simulation has been introduced from 2019. The current review is focused on the need and use of simulated patients; their advantages, limitations and role in students’ teaching and assessment. It also gives a brief outline of their training process. Simulated patients should be used to supplement day-to-day learning, help in transition to attending real patients and also save enormous faculty time in the post-COVID-19 new normal. However, simulated patients are unlikely to completely replace real patients’ experiences.

Simulated Patients for Competency-Based Undergraduate Medical Education Post COVID-19: A New Normal in India

The conventional medical curriculum in India needed more focus on explicit teaching and assessment of interpersonal and communication skills, professionalism, team-work and reflection for prevention and better management of increasing incidences of violence against doctors by building good doctor-patient relationships. Increasing number of seats in Indian medical colleges, decreasing hospital stay of patients, and decrease in faculty requirements will hamper adequate supervised authentic clinical experiences of undergraduates for developing clinical skills. The recent COVID-19 pandemic has led to a significant decrease in student-patient encounters. Simulated patients are being used in many countries to address many of these issues. To make the Indian medical graduates competent to function as primary physician of first contact, competency-based medical education along with guidelines for use of skill-lab and simulation has been introduced from 2019. The current review is focused on the need and use of simulated patients; their advantages, limitations and role in students' teaching and assessment. It also gives a brief outline of their training process. Simulated patients should be used to supplement day-to-day learning, help in transition to attending real patients and also save enormous faculty time in the post-COVID-19 new normal. However, simulated patients are unlikely to completely replace real patients' experiences.

Can student-peers teach using simulated-based learning as well as faculty: A non-equivalent posttest-only study

BACKGROUND

Peer-assisted learning has an important place in the delivery of health care education with benefits for both the learners and the peer teachers. Simulation-based learning (SBL) is evolving in healthcare professions training and academic programs as a modality that conveys realism and fidelity through immersion.

OBJECTIVES

The primary aim was to compare physiotherapy student's motivation to learn between a conventional faculty-led SBL activity and the same SBL activity delivered by trained final year physiotherapy peer tutors.

METHODS

Physiotherapy students from two Universities (n = 226) undertook a SBL learning activity (either faculty led or peer led) and completed the Instructional Materials Motivation Scale questionnaire to assess motivation to learn.

RESULTS

There was a high level of learner motivation in all learning groups, with significantly higher learner satisfaction (p < 0.001) and lower attention (p < 0.001) in student-led SBL than faculty-led SBL.

CONCLUSIONS

This study has highlighted the potential to incorporate peer-assisted and simulation-based learning together in the development of future educational activities in health care training.

Development and evaluation of interprofessional patient simulation activity for physiotherapy and occupational therapy students to assess and manage patients with chronic pain

Background/aims

Opportunities for interprofessional learning are a priority to prepare health professionals for the effective interprofessional assessment and management of patients with chronic pain, yet finding effective and sustainable approaches are a challenge for health professional programmes. The aim of this study was to develop and evaluate an ‘interprofessional management of pain’ learning activity using simulation for physiotherapy and occupational therapy students.

Methods

A total of 40 physiotherapy and 20 occupational therapy students undertook the interprofessional management of pain learning activity. Chronic pain attitudes and beliefs (HC-PAIRS) and perception of interprofessional practice (SPICE-R) were assessed before and following the intervention. A survey relating to content and format of the activity was completed following the intervention.

Results

There was a significant improvement in total HC-PAIRS and SPICE-R scores for both student groups. Both groups demonstrated satisfaction with the activity.

Conclusions

These findings support the use of an interprofessional simulated learning activity with facilitated planning and debriefing to enhance students’ attitudes to chronic pain and interprofessional practice.

Medical Decision-Making in the Physician Hierarchy: A Pilot Pedagogical Evaluation

PURPOSE

Recently, the American College of Graduate Medical Education included medical decision-making as a core competency in several specialties. To date, the ability to demonstrate and measure a pedagogical evolution of medical judgment in a medical education program has been limited. In this study, we aim to examine differences in medical decision-making of physician groups in distinctly different stages of their postgraduate career.

METHODS

The study recruited physicians with a wide spectrum of disciplines and levels of experience to take part in 4 medical simulations divided into 2 categories, abdominal pain (biliary colic [BC] and renal colic [RC]) or chest pain (cardiac ischemia with ST-segment elevation myocardial infarction [STEMI] and pneumothorax [PTX]). Evaluation of medical decision-making used the Medical Judgment Metric (MJM). The targeted selection criteria for the physician groups are administrative physicians (APs), representing those with the most experience but whose current duties are largely administrative; resident physicians (RPs), those enrolled in postgraduate medical or surgical training; and mastery level physicians (MPs), those deemed to have mastery level experience. The study measured participant demographics, physiological responses, medical judgment scores, and simulation time to case resolution. Outcome differences were analyzed using Fisher exact tests with post hoc Bonferroni-adjusted z tests and single-factor analysis of variance F tests with post hoc Tukey honestly significant difference, as appropriate. The significance threshold was set at P < .05. Effect sizes were determined and reported to inform future studies.

RESULTS

A total of n = 30 physicians were recruited for the study with n = 10 participants in each physician group. No significant differences were found in baseline demographics between groups. Analysis of simulations showed a significant (P = .002) interaction for total simulation time between groups RP: 6.2 minutes (±1.58); MP: 8.7 minutes (±2.46); and AP: 10.3 minutes (±2.78). The AP MJM scores, 12.3 (±2.66), for the RC simulation were significantly (P = .010) lower than the RP 14.7 (±1.15) and MP 14.7 (±1.15) MJM scores. Analysis of simulated patient outcomes showed that the AP group was significantly less likely to stabilize the participant in the RC simulation than MP and RP groups (P = .040). While not significant, all MJM scores for the AP group were lower in the BC, STEMI, and PTX simulations compared with the RP and MP groups.

CONCLUSIONS

Physicians in distinctly different stages of their respective postgraduate career differed in several domains when assessed through a consistent high-fidelity medical simulation program. Further studies are warranted to accurately assess pedagogical differences over the medical judgment lifespan of a physician.

The influence of a full-time, immersive simulation-based clinical placement on physiotherapy student confidence during the transition to clinical practice

Background

Novice students may have limited learning opportunities during their early exposure to complex clinical environments, due to the priorities of patient care. Immersive, high-fidelity simulation provides an opportunity for physiotherapy students to be exposed to relatively complex scenarios in a safe learning environment before transitioning to the clinical setting. The present study evaluated the influence of immersive simulation on student confidence and competence.

Methods

Sixty penultimate year physiotherapy students completed an 18-day full-time immersive simulation placement. The placement involved students spending 6 days working in each of three core practice areas (cardiopulmonary, musculoskeletal, neurological) in which they interacted with simulated patients portrayed by professional role-play actors. The patient scenarios were developed by groups of expert practitioners and incorporated full documentary and imaging information. Students completed a questionnaire to evaluate their confidence in the clinical environment at the start and completion of each 6-day rotation. Their clinical competence was evaluated at the end of each 6-day rotation using the Assessment of Physiotherapy Practice (APP) tool. In a secondary analysis, the clinical competence of this cohort was evaluated in comparison to a matched cohort of students from the same year group that had not completed an immersive simulation placement.

Results

Student confidence improved significantly in each 6-day rotation (p < 0.001); however, it reduced again at the commencement of the next rotation, and there was no cumulative improvement in confidence over the 18-day placement (p = 0.22). Students who had completed the immersive simulation placement achieved higher APP (p < 0.001) scores in an evaluation of their competence to practice during their subsequent clinical placement.

Conclusion

Immersive simulation provides a beneficial learning environment to enable physiotherapy students to transition from university-based education to working in the clinical environment.

Electronic supplementary material

The online version of this article (10.1186/s41077-018-0062-9) contains supplementary material, which is available to authorized users.

Challenging conversations with simulated patients

BACKGROUND

Simulation-based learning (SBL) activities in the health sciences provide students with opportunities to interact with realistic patients and environments. This study aimed to develop and then implement a novel activity using simulation for a large group of mostly millennial physiotherapy students, to enhance their ability to communicate with a challenging patient and to assess their motivation to learn.

METHODS

Students enrolled in a second-year communication unit were invited to participate in a non-compulsory unique SBL activity in groups of four for 40 minutes, undertaking two 5-minute simulation scenarios and two debriefing sessions. On completion of the activity, 140 students scored their motivation to learn during the activity using the Instructional Materials Motivation Scale (IMMS) questionnaire.

RESULTS

Of the physiotherapy students enrolled in the unit, 83 per cent took part in the SBL and 100 per cent of the participants completed the follow-up survey. Mean scores for each subscale ranged from 3.8 to 4.0, reflecting that students agreed more than moderately with the statements made in the scale. The median total IMMS score for all students was 149, well above the published median total score of the scale (108). Simulation-based learning activities provide students with opportunities to interact with realistic patients and environments DISCUSSION: The SBL activity model was successfully implemented and received positively by the students in terms of their motivation to learn. It gained the attention of participants by providing an opportunity to practise the non-technical skill of 'communicating with patients', previously learned in the classroom, in a simulated realistic environment and by using a design that seemed to consider the needs of the millennial generation.

Standardized Patients versus Volunteer Patients for Physical Therapy Students' Interviewing Practice: A Pilot Study

PURPOSE

To compare the use of standardized patients (SPs) and volunteer patients (VPs) for physical therapy students' interviewing practice in terms of students' perception and overall costs.

METHODS

Students in the Master of Physical Therapy programme (n=80) at a Canadian university were divided into 20 groups of 4 and were randomly assigned to interview either an SP (10 groups) or a VP (10 groups). Students completed a survey about their perception of the usefulness of the activity and the ease and depth of information extraction. Survey responses as well as costs of the interview exercise were compared between SP and VP groups.

RESULTS

No statistically significant between-groups difference was found for the majority of survey items. The cost of using an SP was $148, versus $50 for a VP.

CONCLUSIONS

Students' perceptions of the usefulness of the activity in helping them to develop their interview skills and of the ease and depth of extracting information were similar for both SPs and VPs. Because the cost of using an SP is about three times that of using a VP, using VPs seem to be a more cost-effective option.

"Thinking on your feet"-a qualitative study of debriefing practice

Background

Debriefing is a significant component of simulation-based education (SBE). Regardless of how and where immersive simulation is used to support learning, debriefing has a critical role to optimise learning outcomes. Although the literature describes different debriefing methods and approaches that constitute effective debriefing, there are discrepancies as to what is actually practised and how experts or experienced debriefers perceive and approach debriefing. This study sought to explore the self-reported practices of expert debriefers.

Methods

We used a qualitative approach to explore experts’ debriefing practices. Peer-nominated expert debriefers who use immersive manikin-based simulations were identified in the healthcare simulation community across Australia. Twenty-four expert debriefers were purposively sampled to participate in semi-structured telephone interviews lasting 45–90 min. Interviews were transcribed and independently analysed using inductive thematic analysis.

Results

Codes emerging through the data analysis clustered into four major categories: (1) Values: ideas and beliefs representing the fundamental principles that underpinned interviewees’ debriefing practices. (2) Artistry: debriefing practices which are dynamic and creative. (3) Techniques: the specific methods used by interviewees to promote a productive and safe learning environment. (4) Development: changes in interviewees’ debriefing practices over time.

Conclusions

The “practice development triangle” inspired by the work of Handal and Lauvas offers a framework for our themes. A feature of the triangle is that the values of expert debriefers provide a foundation for associated artistry and techniques. This framework may provide a different emphasis for courses and programmes designed to support debriefing practices where microskill development is often privileged, especially those microskills associated with techniques (plan of action, creating a safe environment, managing learning objectives, promoting learner reflection and co-debriefing). Across the levels in the practice development triangle, the importance of continuing professional development is acknowledged. Strengths and limitations of the study are noted.

Introducing simulation-based education to healthcare professionals: exploring the challenge of integrating theory into educational practice

BACKGROUND

Introducing simulation-based education to the curricular programme of healthcare professionals can be challenging. This study explored the early experiences of healthcare professionals in the use of simulation. This was in the context of the Kuwait-Scotland transformational health innovation network programme.

METHODS

Two cohorts of healthcare professionals undertook a simulation module as part of faculty development programme in Kuwait. Participants' initial perceptions of simulators were gathered using a structured questionnaire in the clinical skills centre. Their subsequent ability to demonstrate the application of simulation was evaluated through analyses of the video-recordings of teaching sessions they undertook and written reflections of their experiences of using simulation.

RESULTS

In theory, participants were able to identify simulators' classification and fidelity. They also recognised some of the challenges of using simulators. In their teaching sessions, most participants focused on using part-task trainers to teach procedural skills. In their written reflections, they did not articulate a justification for their choice of simulator or its limitations.

CONCLUSION

This study demonstrated a theory-to-practice gap in the early use of simulation by healthcare educators. The findings highlight the need for deliberate practice and adequate mentorship for educators to develop confidence and competence in the use of simulation as part of their educational practice.

Defining the purpose of phantom head

Simulation is a vital part of the learning of restorative dentistry. It provides the student with motor and procedural skills that would be impossible to learning in any other way. However, in order to use preclinical simulation most effectively, its limits need to be understood. Discussion of these rarely appears in the literature. This article identifies some of the purposes of simulation found in more general literature on the subject, and applies these to preclinical dentistry. It also describes some of the limits to simulation in the teaching of restorative dentistry.

Teacher-made models: the answer for medical skills training in developing countries?

BACKGROUND

The advantages of using simulators in skills training are generally recognized, but simulators are often too expensive for medical schools in developing countries. Cheaper locally-made models (or part-task trainers) could be the answer, especially when teachers are involved in design and production (teacher-made models, TM).

METHODS

We evaluated the effectiveness of a TM in training and assessing intravenous injection skills in comparison to an available commercial model (CM) in a randomized, blind, pretest-posttest study with 144 undergraduate nursing students. All students were assessed on both the TM and the CM in the pre-test and post-test. After the post-test the students were also assessed while performing the skill on real patients.

RESULTS

Differences in the mean scores pre- and post-test were marked in all groups. Training with TM or CM improved student scores substantially but there was no significant difference in mean scores whether students had practiced on TM or CM. Students who practiced on TM performed better on communication with the patient than did students who practiced on CM. Decreasing the ratio of students per TM model helped to increase practice opportunities but did not improve student's mean scores. The result of the assessment on both the TM and the CM had a low correlation with the results of the assessment on real persons.

CONCLUSIONS

The TM appears to be an effective alternative to CM for training students on basic IV skills, as students showed similar increases in performance scores after training on models that cost considerably less than commercially available models. These models could be produced using locally available materials in most countries, including those with limited resources to invest in medical education and skills laboratories.

Use of simulated patients for a student learning experience on managing difficult patient behaviour in speech-language pathology contexts

A student learning experience about managing difficult patients in speech-language pathology is described. In 2006, 40 students participated in a daylong learning experience. The first part of the experience consisted of presentations and discussions of different scenarios of interpersonal difficulty. The theoretical introduction was followed by an active learning experience with simulated patients. A similar experience without the simulated patients was conducted for 45 students in 2010. Both years of students rated the experience with an overall grade and gave qualitative feedback. There was no significant difference between the overall grades given by the students in 2006 and 2010. The qualitative feedback indicated that the students valued the experience and that they felt it added to their learning and professional development. The students in 2006 also provided detailed feedback on the simulation activities. Students endorsed the experience and recommended that the learning experience be repeated for future students. However, the students in 2006 also commented that they had felt inadequately prepared for interacting with the simulated patients. A learning experience with simulated patients can add to students' learning. The inclusion of simulated patients can provide a different, but not automatically better, learning experience.

Use of technology to enhance student self evaluation and the value of feedback on teaching

Background: Assessment using case based practical exams that require demonstration of clinical practice skills and articulation of clinical reasoning is commonly used in undergraduate allied health and nursing professions. However, the student often struggles in understanding and evaluating their performance of practical skills in preparation for summative practical assessment tasks. The fear of attempting and completing practical tasks does not contribute to learning. Any means of encouraging self evaluation, refection and facilitating learning that is driven by the learner and not the assessor will contribute to the performance of the student in the short term and the practitioner in the future.

Aims: This project used a mixed-methodological approach to explore the use of audio-visual technology to enhance 61 undergraduate physiotherapy students' practice of self evaluation and then sought to explore and understand the student experience of the activity and the teacher feedback provided.

Findings: Themes relating to the students concerns, strengths and levels of self-confidence were identified. Refection on the student feedback provided and the implications for teaching are also discussed.

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.

A review of standardized patients in clinical education: Implications for speech-language pathology programs

The use of standardized patients has been reported as a viable addition to traditional models of professional practice education in medicine, nursing and allied health programs. Educational programs rely on the inclusion of work-integrated learning components in order to graduate competent practitioners. Allied health programs world-wide have reported increasing difficulty in attaining sufficient traditional placements for students within the workplace. In response to this, allied health professionals are challenged to be innovative and problem-solving in the development and maintenance of clinical education placements and to consider potential alternative learning opportunities for students. Whilst there is a bank of literature describing the use of standardized patients in medicine and nursing, reports of its use in speech-language pathology clinical education are limited. Therefore, this paper aims to (1) provide a review of literature reporting on the use of standardized patients within medical and allied health professions with particular reference to use in speech-language pathology, (2) discuss methodological and practical issues involved in establishing and maintaining a standardized patient program and (3) identify future directions for research and clinical programs using standardized patients to build foundation clinical skills such as communication, interpersonal interaction and interviewing.

Integrated case learning: teaching clinical reasoning

Learning how to 'think like doctors' can be difficult for undergraduate medical students in their early clinical years. Our model of collaborative Integrated Case Learning (ICL) and simulated clinical reasoning aims to address these issues. Taking a socio-cultural perspective, this study investigates the reflective learning interactions and practices of clinical thinking that emerged in the ICL environment. We also explore how third year medical students perceived their ICL experiences in relation to the clinical situations encountered in the hospital setting. The context for the inquiry is a rural Clinical School in North West Victoria, Australia. We used a qualitative case study methodology following eight third-year medical students over an academic year. Individual and group interviews were conducted, together with observations and document/artefact analysis. Data was analysed using content and narrative methods. The ICL program was well received. Findings suggest that the group-based, simulated clinical reasoning process appears to help undergraduate medical students to rehearse, articulate and question their clinical decision-making pathways. We argue that the ICL process offers a professionally challenging, but supportive group learning 'space' for students to practise what it might mean to 'think', 'talk' and 'perform' like doctors in real settings. The ICL environment also appears to create a connective bridge between the 'classroom' and clinical practice.

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.

Survey of psychiatrists' views of nurse prescribing

For mental health nurses and service users to realize the benefits of non-medical prescribing, psychiatrists need to understand the remit of this role and be actively involved in influencing it. Although healthcare policy in the UK supports the expansion of non-medical prescribing, it requires much more for the successful implementation of such initiatives in practice. The aim of this survey was to explore the attitudes of all grades of psychiatrist working in two mental health trusts in the West Midlands to nurse prescribing. A specifically designed questionnaire was sent out to two groups of psychiatrists to assess their attitudes towards non-medical prescribing. Psychiatrists (n = 147) completed and returned a specifically designed questionnaire of their views. The more senior doctors appeared less concerned about nurse prescribing. Junior doctors expressed equivocation towards the role, suggesting that nurse prescribers be consistently supervised and have limited access to mental health drugs. The findings from this study have considerable implications for teams if junior doctors hold different views to their senior colleagues. Without the assistance of trusts in facilitating role change, the introduction of new roles could potentially heighten conflict between professions.

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

BACKGROUND

Simulated patients (SPs) are widely used in medical education. The literature offers little evidence for scenario or SP role development. Published materials describe guidelines for structuring roles but there is little information on process. Anecdotal evidence suggests that SP roles are usually created by health care professionals and teachers. Although this approach has advantages it places the role at risk of omitting or misrepresenting real patients' experiences.

AIM

We wanted to explore a systematic approach to role development that was based on individual patient's experiences.

METHODS

Real patients were interviewed about their experiences of procedures they had undergone. This information formed the basis of our procedural skills SP roles.

RESULTS

Eight new roles were created. Evaluation by SPs (n = 22) showed more positive comments about realism on roles based on real patients' experiences compared with those crafted by our multidisciplinary team although there were no statistically significant differences in numerical ratings.

CONCLUSIONS

The approach to writing roles described here is not suited to all simulations. However, it offers guidance to those involved in writing scenarios and has led us to critically reflect on the ways in which we provide educational materials that are patient focused.

Learner-centred feedback using remote assessment of clinical procedures

This paper describes the Imperial College Feedback and Assessment System (ICFAS) and explores its feasibility in supporting the learning of practical clinical procedures. ICFAS is an innovative combination of existing technologies which brings together video recording, networked mobile computers (laptop and handheld) and content management software. The aim is to observe, record, assess and provide feedback on multiple simulated encounters. We have developed ICFAS within the framework of our Integrated Procedural Performance Instrument (IPPI) (Kneebone et al. 2006a,b), providing a technology-based 'feedback space' for maximizing educational value.