An Evaluation of the Use of Simulated Patient Role-Plays in the Teaching and Assessment of Clinical Consultation Skills in Clinical Psychologists' Training

Psychologists and Integrated Behavioral Health Simulation Training: A Survey of Medical Educators and Perspectives of Directors of Clinical Training

It is well established that the integration of behavioral healthcare into the medical home model improves patient outcomes, reduces costs, and increases resident learning. As academic health centers increasingly integrate behavioral healthcare, targeted training for interprofessional collaboration around behavioral healthcare is needed. Simulation educational approaches potentially can provide this training. Health service psychologists are well-poised to support this because of their specialized training in integrated healthcare. The present exploratory study aimed to evaluate existing simulation programs and develop recommendations for integrated behavioral health training and evaluation. Directors of ACGME accredited residency programs that are high utilizers of the medical home model (Pediatrics, Internal Medicine, Medicine/Pediatrics, Family Medicine) as well as Psychiatry residencies and medical schools with membership in the Society for Simulation in Healthcare were recruited to complete a 26-item survey to assess program usage of psychologists as part of simulation training for integrated behavioral healthcare services. Of 79 participants who completed initial items describing their training program, only 32 programs completed the entire survey. While many academic health centers offered integrated team and behavioral health simulations, few utilized psychology faculty in design, implementation, and evaluation. Other behavioral health providers (psychiatrists, social workers) were often involved in medical school and pediatric residency simulations. Few institutions use standardized evaluation. Qualitative feedback and faculty-written questionnaires were often used to evaluate efficacy. Survey responses suggest that psychologists play limited roles in integrated behavioral healthcare simulation despite their expertise in interdisciplinary training, integrated behavioral healthcare, and program evaluation.

Konzeption des longitudinalen DYNAMIK-Curriculums

Hintergrund

Durch die Einführung des neuen „Psychotherapiestudiums“ zum Herbst 2020 und die Wünsche bisheriger Ausbildungsteilnehmer an psychotherapeutischen Ausbildungsinstituten ist die Notwendigkeit gegeben, erfahrungsbasierte und kompetenzorientierte Lehre in das zukünftige Studium und die nachfolgende Weiterbildung werdender Psychotherapeuten zu integrieren.

Material und Methode

Orientiert am Kern-Zyklus, einem bedeutenden Modell zur Curriculumsentwicklung, werden die Entwicklung, Konzeptionalisierung und Implementierung eines longitudinalen Curriculums zur Vermittlung psychodynamischer Interventionskompetenzen (DYNAMIK-Curriculum) in die derzeitige Ausbildung zum psychologischen Psychotherapeuten vorgestellt.

Ergebnisse

Es wurde ein longitudinales Curriculum mit 8 Modulen zur Vermittlung allgemeiner und spezifischer psychodynamischer Interventionskompetenzen mithilfe von Peer-Rollenspielen und standardisierten Patienten entwickelt. Dieses stellt seit Mitte 2019 einen integralen Bestandteil der Ausbildung zum tiefenpsychologisch fundierten Psychotherapeuten am Heidelberger Institut für Psychotherapie (HIP) dar.

Schlussfolgerung

Das DYNAMIK-Curriculum ist der erste wichtige Schritt in Richtung der longitudinalen erfahrungsorientieren, praxisnahen Kompetenzorientierung in der derzeitigen Ausbildung und dem zukünftigen Studium mit nachfolgender Weiterbildung von psychologischen Psychotherapeuten. Es resultiert die Notwendigkeit zur Wirksamkeitsüberprüfung solcher Curricula und zur praktischen Prüfung von Interventionskompetenzen.

Can Psychotherapy Trainees Distinguish Standardized Patients From Real Patients?

Abstract. Background: Under the new psychotherapy law in Germany, standardized patients (SPs) are to become a standard component in psychotherapy training, even though little is known about their authenticity. Objective: The present pilot study explored whether, following an exhaustive two-day SP training, psychotherapy trainees can distinguish SPs from real patients. Methods: Twenty-eight psychotherapy trainees ( M = 28.54 years of age, SD = 3.19) participated as blind raters. They evaluated six video-recorded therapy segments of trained SPs and real patients using the Authenticity of Patient Demonstrations Scale. Results: The authenticity scores of real patients and SPs did not differ ( p = .43). The descriptive results indicated that the highest score of authenticity was given to an SP. Further, the real patients did not differ significantly from the SPs concerning perceived impairment ( p = .33) and the likelihood of being a real patient ( p = .52). Conclusions: The current results suggest that psychotherapy trainees were unable to distinguish the SPs from real patients. We therefore strongly recommend incorporating training SPs before application. Limitations and future research directions are discussed.

Standardized patients in psychotherapy training and clinical supervision: study protocol for a randomized controlled trial

Background

Psychotherapy is highly effective and widely acknowledged for treating various mental disorders. Nevertheless, in terms of methods for teaching effective psychotherapeutic approaches and competencies, there has been a lack of investigation. Training and supervision are the main strategies for teaching therapist competencies, and standardized role-plays with simulated patients (i.e., trained individuals playing someone with a mental disorder) seem useful for evaluating training approaches. In medical education, this procedure is now internationally established. However, so far, little use has been made of standardized role-playing to evaluate training and supervision in the area of clinical psychology and psychotherapy.

Methods

In this study, standardized role-plays are used to evaluate methods for training and supervision. Central cognitive behavioral approaches for treating depression are taught in the training. The first experiment compares an active training approach (i.e., model learning) with a passive one (i.e., reading manual-based instructions). The second experiment compares a direct supervision technique (i.e., supervision based on video analysis) with an indirect one (i.e., supervision based on verbal reporting). In each experiment, 68 bachelor’s and master’s students of psychology will be randomly assigned to the experimental and control groups. Each student takes part in three role-plays (baseline, post and 3-month follow-up), which are all videotaped. Two independent raters assess therapist competencies in each role-play on the basis of a standardized competence scale.

Discussion

The research project aims to contribute to the development of specific training and supervision methods in order to improve psychotherapy training and patient care.

Trial registration

ISRCTN Registry, ISRCTN19173895. Registered on 10 December 2019.

Standardized Patients in Clinical Psychology and Psychotherapy: a Scoping Review of Barriers and Facilitators for Implementation

OBJECTIVES

The use of simulated and standardized patients (SP) is widely accepted in the medical field and, from there, is beginning to disseminate into clinical psychology and psychotherapy. The purpose of this study was therefore to systematically review barriers and facilitators that should be considered in the implementation of SP interventions specific to clinical psychology and psychotherapy.

METHODS

Following current guidelines, a scoping review was conducted. The literature search focused on the MEDLINE, PsycINFO and Web of Science databases, including Dissertation Abstracts International. After screening for titles and abstracts, full texts were screened independently and in duplicate according to our inclusion criteria. For data extraction, a pre-defined form was piloted and used. Units of meaning with respect to barriers and facilitators were extracted and categorized inductively using content-analysis techniques. From the results, a matrix of interconnections and a network graph were compiled.

RESULTS

The 41 included publications were mainly in the fields of psychiatry and mental health nursing, as well as in training and education. The detailed category system contrasts four supercategories, i.e., which organizational and economic aspects to consider, which persons to include as eligible SPs, how to develop adequate scenarios, and how to authentically and consistently portray mental health patients.

CONCLUSIONS

Publications focused especially on the interrelation between authenticity and consistency of portrayals, on how to evoke empathy in learners, and on economic and training aspects. A variety of recommendations for implementing SP programs, from planning to training, monitoring, and debriefing, is provided, for example, ethical screening of and ongoing support for SPs.

Training Methods in Cognitive Behavioral Therapy: Tradition and Invention

Cognitive behavioral supervisors influence new generations of clients and clinicians. Accordingly, the task is meaningful, rewarding, challenging, and critically important. This article describes traditional and unconventional approaches to supervising clinicians in cognitive behavioral therapy (CBT). Traditional methods such as the use of the Cognitive Therapy Rating Scale, videotape/audiotape review, live supervision, and cotherapy are reviewed. Further, inventive procedures for teaching supervisees cognitive flexibility, empathy, tolerance for ambiguity, and remaining steadfast when faced with negative emotional arousal are explained. Popular media, improvisation and acting exercises, and working with professional actors as teaching methods are explained.

Assessing Trainee Clinical Psychologists' Clinical Competence

Within UK clinical psychology training, traditionally used methods for assessing the development of trainees' clinical competence have taken the form of evaluations of trainee knowledge regarding their clinical practice, either in the form of written assignments or via discussion in the supervisory relationship. Whilst direct observation of trainees is expected and required by supervisors on practice placements, frequency of observation varies, and supervisors can experience difficulties occupying both supervisory and evaluatory roles. In addition, calls from within the clinical psychology training community have expressed a need for a consistent and formalised in vivo assessment of trainees' clinical competency (Gallichan & Mitchell, 2008). This article reports on a psychometric evaluation of the Clinical Skills Assessment Rating Form (CSA-RF), a seven domain measure of clinical competence developed at the University of Leicester Doctoral Programme in Clinical Psychology for use with live or videotaped clinical material. Results suggest that the CSA-RF has acceptable levels of internal consistency, although interrater reliability requires further investigation. Factor analysis revealed a five domain structure. From this, a revised CSA-RF has been developed which aims to be a valid and practicable initial means by which trainees' clinical competence can be assessed.